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Protocol for pulse therapy of methylprednisolone and dexamethasone

Both methylprednisolone and dexamethasone may be given as big shots which are actually not stat doses but infusions given over a time of 2 to 3 hours

Duration of therapy maybe a single dose given once daily for 3 days or on alternate day over 5 days. Total 3 doses.

The corticosteroid preparation is dissolved in 200 ml of 5% dextrose water and infused very slowly intravenously over 3 hours

Before starting therapy it must be made sure that the patient does not have any severe systemic infection however minor upper respiratory tract infections gastrointestinal or skin infections are not a contraindication

The vital signs of the patient must be normalised especially the blood pressure of the patient should be in normal range

Among labs obtained total and differential white blood cell count get blood sugar level and serum urea and serum creatinine and serum Sodium and potassium

Once these parameters are normal we are safe to proceed

During the therapy record pulse rate respiratory rate blood pressure every 30 minute

If possible attach chest electrodes for cardiac monitoring such that arrhythmia may be picked up early

If arrhythmias occur immediately stop the infusion and manage accordingly as suggested in advanced cardiac life support and send blood levels of serum Sodium Potassium calcium magnesium

Following the therapy and during the days of therapy serum electrolytes and calcium and magnesium are to be repeated after every 24 hours , blood sugar should also be repeated 24 hours

Finally

At the end of therapy patient must be monitored for new infection or reactivation of a previous infection.

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