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Complications of steroides

Complications Associated with Corticosteroid Therapy:

Whenever a patient begins a course of corticosteroid therapy, the potential for complications is great. Dosing regimens vary widely, depending on the underlying hematologic condition and the patient’s response to the medication. For example, several chemotherapy protocols include high doses of corticosteroids for a period of several days. After that time, the medication is stopped abruptly without tapering the dosage. In other conditions, such as idiopathic thrombocytopenic purpura or hemolytic anemias, the corticosteroids are very carefully tapered to prevent a flare up of the underlying disease. 

With the exception of patients with preexisting conditions such as diabetes, hypertension, and osteoporosis, it is difficult to predict which complications will occur in a given patient. Patients who receive high doses of corticosteroids for longer than a few weeks should be screened for symptoms related to the potential complications listed here. If at all possible, patients who require long-term corticosteroid use should be switched to an alternate-day dosing schedule; this method may diminish the severity of complications that arise.

Short-Term Complications

Fluid and Electrolyte Complications

  • Fluid retention
  • Sodium retention
  • Potassium loss
  • Hypokalemic alkalosis
  • Hypertension

Endocrine Complications

  1. Decreased carbohydrate tolerance
  2. Diabetes mellitus
  3. Uncontrolled glucose levels in diabetes mellitus

Neurologic Complications

  • Headache
  • Musculoskeletal Complications
  • Muscle weakness

Psychologic Complications

  • Depression
  • Euphoria
  • Mood swings
  • Insomnia
  • Psychosis

 Long-Term Complications

Endocrine Complications

  • Decreased adrenocortical activity
  • Decreased ability to respond to stress
  • Decreased carbohydrate tolerance
  • Decreased growth rate (children)
  • Cushingoid state
  • Menstrual irregularities
  • Increased sweating

Metabolic Complications

  • Protein catabolism causing negative nitrogen balance

Gastrointestinal Complications

  • Gastritis
  • Ulcerative esophagitis
  • Peptic ulcer
  • Pancreatitis

Musculoskeletal Complications

  • Decreased muscle mass
  • Osteoporosis
  • Vertebral compression fracture
  • Pathologic fracture
  • Aseptic necrosis of femoral and humeral heads

Neurologic Complications

  • Vertigo
  • Increased intracranial pressure
  • Seizures

Ophthalmic Complications

  • Cataract formation
  • Glaucoma
  • Exophthalmos

Dermatologic Complications

  • Impaired wound healing
  • Ecchymoses
  • Increased skin fragility
  • Decreased skin thickness
  • Petechiae

Immunologic Complications

  • Decreased response to infection
  • Masked signs of (early stages of infection)
  • Suppressed reaction to skin tests
  • Increased risk for opportunistic infection (eg, Pneumocystis, herpes zoster)