Pharmacological and Parenteral Therapies Q 10
A nurse in the emergency department assesses a patient who has been taking long-term corticosteroids to treat renal disease. Which of the following is a typical side effect of corticosteroid treatment? Select all that apply.
A. Hypertension
B. Cushingoid features
C. Hyponatremia
D. Low serum albumin
E. Hypernatremia
Correct Answer: A, B, & D
Side effects of corticosteroids include weight gain, fluid retention with hypertension, Cushingoid features, a low serum albumin, and suppressed inflammatory response. Patients are encouraged to eat a diet high in protein, vitamins, and minerals and low in sodium.
Option A: Corticosteroid use is associated with hypertension, hyperglycemia, obesity, and conflicting evidence exists for hyperlipidemia. Mineralocorticoid activity, which varies by corticosteroid, leads to retention of free water and sodium with excretion of potassium.
Option B: Cushing syndrome can occur in patients taking corticosteroids through all routes of administration. Cushingoid features refer to the weight gain and the redistribution of adiposity (dorsocervical fat pad, aka “buffalo hump,” facial fat increase, aka “moon facies,” and truncal obesity) seen with excess cortisol. These features may develop within the first two months of corticosteroid treatment.
Option C: Corticosteroids cause hypernatremia, not hyponatremia. Corticosteroids have varying degrees of mineralocorticoid activity. The corticosteroids with higher levels of mineralocorticoid activity may lead to free water and salt retention in addition to potassium excretion. Thus, fluid and electrolyte levels should be monitored in patients on corticosteroids with higher mineralocorticoid activity.
Option D: There was a significant correlation between the extent of plasma protein binding of prednisolone and the serum albumin concentration. Azathioprine did not affect the plasma binding of prednisolone in vitro. The plasma half-life of prednisolone was prolonged in two of three patients with chronic liver disease studied. These, together with low serum albumin concentrations which are associated with higher levels of circulating unbound prednisolone, result in quite different levels of biologically active corticosteroids compared with equivalent doses of prednisone or prednisolone in subjects without liver disease.
Option E: Glucocorticoid can induce hypernatremia not only by enhancing sodium retention, but also by increasing electrolyte-free water loss. It has been shown that patients, as well as experimental animals, exhibit polyuria in the presence of excess glucocorticoid hormones.