Steroid Stan — Corticosteroid Therapy: Never Stop Abruptly, Watch Sugar and Hidden Infection
He felt better, so he stopped his prednisone on Friday — by Sunday his pressure was bottoming out
Stan's face is round, his arms bruise easily, and after stopping prednisone on his own he arrives weak, nauseated and hypotensive.
Stan takes long-term prednisone. Corticosteroids suppress the adrenal glands, so stopping abruptly can trigger adrenal crisis — the dose must be TAPERED. They also raise blood glucose, raise infection risk while masking its signs (a low-grade fever may be the only clue), cause fluid retention, weight gain, mood changes, thinning skin, easy bruising, and over time osteoporosis, cataracts and a cushingoid appearance. Teaching: take with food in the morning, monitor glucose and weight, avoid people who are ill, never skip or stop doses, and carry medical alert identification.
Read Steroid Stan's full story →The story arc
The setup
Stan starts long-term prednisone for an inflammatory condition and quickly feels better.
The turn
Over months his face rounds out, he gains weight, his sugar rises and his skin bruises with the lightest bump.
The crisis
Feeling well, Stan stops the medication cold. Within two days he is weak, nauseated, dizzy and hypotensive.
The save
Steroids are restarted and tapered properly. Stan learns to take them in the morning with food, check his glucose, report any fever and never stop on his own.
NCLEX study section — Corticosteroid Therapy: Never Stop Abruptly, Watch Sugar and Hidden Infection
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pharmacology
Take this chapter into practice questions on the same topic.