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SOLUMEDROL (Corticosteroid) PROTOCOL: For Neuromuscular Diseases

• History & Physical examination
• Blood: CBC, Electrolytes, Blood Glucose, PT, PTT
• Other: Chest X-ray, EKG

• Start IV Heparin-lock
• Flush q shift with 2cc NS

• Solumedrol IV 250 mg in 100cc NS q 6 hr, given over 1 hr, x 20 doses (total of 5 gm)
• House officer (HO) to remain with patient for lst 15 min of first infusion
• Evaluate time schedule for infusion to minimize sleep interruption
• NOTE: Dexamethasone can probably be substituted at a conversion of 5:1
      (ie 1 gram Solumedrol = 200 mg Dexamethasone)

• Pepcid 20 mg po BID
• Ambien 5 mg po qHS prn

• EKG after completion of 1^st dose
• Notify HO for T > 38.0, SOB or cardiac symptoms
• Guaiac all stools; Notify HO if positive
• Monitor blood glucose 2 hr after first 3 Solumedrol doses; Notify HO if > 250

• Consult PT and OT
• Arrange Home IV therapy for additional treatment after discharge

• Write Prescription for: OUTPATIENT Solumedrol IV
• Begin outpatient Solumedrol 1 week after discharge
• Doses
  • One gram infused over 2 - 3 hr, q week x 4
  • Then q every other week x 4
• Lab testing
  • CBC, electrolytes and blood glucose q month
  • FAX results to Dr. Pestronk at 314-362-2826
  • Follow-up in Neuromuscular Clinic in 3 months