Methylprednisolone IM

[Av8or007]

Just a quick question:

First, what is the equivalent dose to 40-60 mg of po prednisone when using methylprednisolone?

Second, can you give Solu-Medrol IM in the acute setting, e.g. for asthma exacerbation or adjunctive tx for anaphylaxis?

If so how does im dosing equate to iv dosing? Obviously absorption would be slower, but is 1 mg im = 1 mg iv push?

I am asking this purely for knowledge, especially in the setting of remote/wilderness med.

 

[Summit]

Both are medium acting corticosteroids. Conversion is 32-48mg.

Yes, IM is slower absorption than IV but dosing is typically 1:1. IV is preferable, but wilderness situations can make that harder.

You can give a lot more than 40mg IM in many of these patients. Obviously, this is a second treatment for severe asthma exacerbation and anaphylaxis.

In all situations, but especially in wilderness situations, it is important to understand medication adverse effects.

 

[Av8or007]

Ok thanks.

So one could give the 125 mg of solumedrol normally given IV, IM in a 1:1 ratio?

I have a WFR/EMT-B plus other medical knowledge that exceeds wfr (anat and phys, pathophys, pharmacology .etc).

This is obviously for knowledge as if one were to use these drugs it would be w/ an Rx. + med direction/standing orders.

Can you elaborate on the adverse effects of a burst course of corticosteroids for purposes of learning?

I know they are potent immunosuppressant agents and can significantly increase Ifxn risk, but what others are there for short term burst therapy?
The others i could think of are adverse effects on diabetics due to their effect on glucose metabolism.

 

[Summit]

In burst dosing, yes you are likely get hyperglycemia, particularly in diabetics with DKA and HHS being common complications if not managed appropriately. Are you prepared to manage that in an extended evac? Also, fluid retention and thus HF exacerbation is a concern (particularly if you are remote industrial medicine vs wilderness medicine, where you are more likely to encounter patients susceptible, also consider fluid resuscitated anaphylaxis patients). Less acute, but possibly very problematic in a wilderness situation is corticosteroid induced mood changes and psychosis, particularly in patients with preexisting psychiatric issues. Moving on to less common side effects, seizure is another notable risk. So is dysrhythmia and AMI.

Airway is first, and if your other interventions aren't doing the trick...

I've seen recommended doses of 240mg IM in place of oral burst for asthma, even in older children. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
You can end up needing higher doses if they are on cytochrome P450 3A4 inducers (probably causes increased solumedrol metabolism).

Remember, not all formulations are IV suitable (acetate, the typical IM formulation). In a wilderness situation, you want to be thinking about a hasty evacuation but have enough to keep up dosing through an extended evacuation.

I don't know of any state in the US that would allow a WEMT to do this unless you have super special waiver for your organization. But I see you are in Canada?

 

[Av8or007]

Thanks for the detailed reply.

Yes, I'm in Canada. Most of the protocols kick in as soon as it is considered wilderness context.

Like I said I'm really just asking this for knowledge purposes.