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SOLUMEDROL (Corticosteroid) PROTOCOL: For Neuromuscular Diseases

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

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

• Days 1 & 2: Solumedrol IV 250 mg in 100cc NS q 6 hr, given over 1 hr, x 8 doses (total of 2 gm)
• Day 3: Solumedrol IV 500 mg in 100cc NS q 12 hr, given over 1 to 2 hrs, x 2 doses (total of 1 gm)
• Days 4 & 5: Solumedrol IV 1000 mg in 100cc NS qd, given over 2 to 3 hrs, x 2 doses (total of 2 gm)
• Direct observation of 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 physician for Temp > 38.0, SOB or cardiac symptoms
• Guaiac all stools: Notify physician if positive
• Monitor blood glucose 2 hr after first 3 Solumedrol doses; Notify physician if > 250

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

• Write Prescription for: OUTPATIENT Solumedrol IV
• Begin weekly outpatient Solumedrol 1 week after discharge
• Doses
  • One gram infused over 2 - 3 hr, q week x 4
  • Then: One gram q every week, or every other week, x 4
  • Then: Quantitate strength & Plan further treatments
• Lab testing
  • CBC, electrolytes and blood glucose q month
  • FAX results to Dr. Pestronk at 314-362-3752
  • Follow-up in Neuromuscular Clinic in 3 months: Assessment & Quantitative muscle testing