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"I need steroids, STAT!" But do you? Do you?!
Are steroids always life-savers? A veterinary criticalist weighs in.
Many veterinarians think that patients should never die without the use of corticosteroids. But is this really true? If all else fails, reach for a corticosteroid? Not always, says emergency and critical care specialist Dr. Daniel Fletcher. Corticosteroids can do wonders in some cases, and he advises that you use the CIA to guide you in when their use is indicated in emergency cases. (Note: This is a mnemonic device, not the actual CIA. No men in black suits here.)
Fletcher says because of the multitude of corticosteroid use recommendations in emergency cases out theresome of which corticosteroids are indeed useful for and some of which they can actually be harmful forhe and a fellow criticalist came up with the CIA for acceptable corticosteroid use:
C is for cancer since some types of cancer that will respond well to corticosteroids.
I is for immune-mediated diseases such as immune-mediated hemolytic anemia, immune-mediated thrombocytopenia and immune-mediated skin disease.
A is for conditions such as atopy, asthma, allergy, anaphylaxis and Addisons disease. It seems like a lot of them seem to fall under the As, says Fletcher.
So when are corticosteroids a no-no? Fletcher says new evidence in the literaturemuch in human literaturesuggests that corticosteroid use is not a good idea in some diseases that veterinarians have classically used them forspinal cord injury, head trauma and shock. I think those are three that a lot of people use steroids for, and I would argue that if you look at the current literature, its not very well supported, he says. The harm: They can cause complications such as infection, immunosuppression and gastric ulceration.
If you're not sure when to reach for a corticosteroid, Fletcher has three questions to ask yourself to help make that determination:
- Is there a definite benefit associated with it for the disease you are treating?
- Are there risks associated with it? (There are always risks associated with steroids for any patient you give them to, says Fletcher.)
- Do the benefits outweigh the risks in those cases?
As for which corticosteroid to use, Fletcher likes injectable dexamethasone sodium phosphate for his emergency cases. "It's important to remember, though, that dexamethasone is a whole lot more potent that prednisone, which is what we're using for chronic therapy," says Fletcher. "So if you're thinking you want 0.5 mg/kg of prednisone, don't pick up the dexamethasone bottle and give 0.5 mg/kg of that. Remember that dexamethasone is about 10 times as potent, so you really want to cut that dose way down."
Hear more in this interview with Dr. Sarah Wooten, our practitioner in the trenches: