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True story...8 month old prev healthy dx'd with asthma by their PCP who treated for 21 days with prednisolone 2 mg/kg...child presented to ED on day 25 after start of prednisolone, 4 d post end of steroids in obvious sepsis...pancultured and empiric antibiotics+ACV started...blood cx+ for yeast in 12h, CSF+ for yeast as well, child herniated at 18h.  Final path: Candida albicans in every body fluid.

The lesson I took from this patient was not to 'fear' steroids but have a healthy respect for this class of drug that [due to little Class I evidence] is still prescribed, largely on an empiric basis.  Furthermore, the prescribed dose and duration was arguably too large, of debatable benefit and unconventional.

>>> "Mark D. Moncino, MD" <[log in to unmask]> 09/08/01 12:20 PM >>>
One month.............no real risk for less than that.   Having said that,
I am not sure there is a reason for a pediatrician or ER doc'to be putting
kids on the equivalent of 2 mg/kg/day for that long.  Nonetheless, if one
did, I would tell parents, and document in the chart, about VZ risks and
the need to inform their MD's IF the chid becomes severely ill after a
somewhat prolonged course of steroids.   The child with a subspecialist
following them will be a red flag to future providers......not so if the
Pediatrician or ER doc places a child on an extended course of steroids.

Even with the lack of medical concern ......the lawyers who turn good care,
into malpractice cases, necessitates the extra documentation.

mark

At 03:06 AM 9/7/2001, Dr. Mosarrat Qureshi wrote:
>Dear Netters,
>
>What is the consensus for tapering steroids? i.e. after putting a child on
>systemic steroids e.g. prednisolone 2mg/kgday for how long, you need to
>taper it off rather than stopping it abruptly ?
>In other words, how many days after being on systemic steroids--good
>dose--are you concerned about Adrenal suppression?
>
>Thanks in advance
>
>Dr. Mosarrat J. Qureshi,  M.D.
>Pediatritian
>King Khalid University Hospital,
>Riyadh, Saudi Arabia
>
>For more information, send mail to [log in to unmask] with the
>message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
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