What lab tests and assessments are recommended before initiating a short course of steroids in a vitals stable patient?

Pre-Steroid Assessment for Vitals Stable Patients

Before initiating a short course of steroids in a vitals stable patient, blood glucose, blood pressure, and electrolytes should be checked, along with screening for risk factors for steroid-related complications.

Essential Laboratory Tests

• Blood glucose: Critical to check as steroids can cause significant hyperglycemia, especially with dexamethasone and methylprednisolone 1
• Complete blood count: To establish baseline and rule out infection 2
• Electrolytes (including calcium and magnesium): To identify any pre-existing abnormalities 2
• Blood pressure measurement: Steroids can cause or worsen hypertension 2
• Blood urea nitrogen and serum creatinine: To assess renal function 2
• Liver function tests: To identify contraindications or need for dose adjustment 2
• Thyroid-stimulating hormone: To rule out thyroid dysfunction that may be exacerbated by steroids 2, 3

Risk Factor Assessment

Metabolic Risks

• Diabetes status: Patients with diabetes require more vigilant glucose monitoring as steroids can cause significant hyperglycemia 4
• Weight and BMI: Obesity increases risk of metabolic complications 2
• Lipid profile: Baseline for monitoring steroid effects on cholesterol 2

Cardiovascular Risks

• Orthostatic blood pressure changes: To identify autonomic dysfunction 2
• Cardiovascular disease history: Steroids may worsen heart failure or hypertension 2

Bone Health Risks

• History of fragility fractures: Increases risk of steroid-induced osteoporosis 2
• Prior prolonged steroid use: Cumulative exposure increases risk 2
• Age >40 years: Higher risk for bone density loss 2

Medication Review

• Current medications: Check for potential drug interactions
• Prior steroid use: Assess for adrenal suppression risk 2
• History of alcohol use, illicit drugs, alternative therapies: May interact with steroids 2

Special Considerations

For Diabetic Patients

• More frequent glucose monitoring: Particularly with dexamethasone or methylprednisolone 1, 5
• Consider adjusting diabetes medications: Hyperglycemia may persist for 24-72 hours after injection 6

For Patients with Prior Steroid Use

• Assess for adrenal suppression: May need stress dosing if recently on steroids 3
• Morning cortisol level: Consider if recent steroid use (>3 weeks) 3

Common Pitfalls to Avoid

1. Failing to check glucose in non-diabetic patients: Even patients without diabetes can develop significant hyperglycemia 4

2. Overlooking blood pressure monitoring: Steroids can cause rapid elevation in blood pressure 2

3. Not considering drug interactions: Particularly with medications metabolized by CYP3A4

4. Ignoring recent steroid exposure: May lead to adrenal insufficiency upon withdrawal 2

5. Not educating patients about side effects: Patients should be informed about potential mood changes, insomnia, increased appetite, and fluid retention 2

By following this structured assessment approach, clinicians can minimize risks associated with short-course steroid therapy while maintaining its therapeutic benefits for patients.