[Lactic acidosis: a complication of spinal cord injury in multiple trauma].
Large-dose methylprednisolone has been advocated to lessen neurologic deficits in spinal cord injury for nearly a decade despite confounding statistical results in the Second National Acute Spinal Cord Injury Study (NASCIS-2). Recent retrospective studies found lack of significant functional improvement, increases in the incidence of infectious complications and an increase in ventilated and intensive care days in steroid-treated groups. We report on five cases with severe hyperglycemia and nonketotic metabolic acidosis in otherwise non-diabetic patients with multiple blunt injuries and an associated spinal cord injury. Those adverse effects were induced by epinephrine and aggravated by methylprednisolone. We conclude that high-dose methylprednisolone should be avoided in multiple injured or otherwise compromised patients potentially needing catecholamine support.
Hasse
W
W
Abteilung für Anästhesie, Intensiv- und Rettungsmedizin, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg.
Weidtmann
A
A
Voeltz
P
P
D000140:Acidosis, Lactic / Q000097:blood / Q000139:chemically induced*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001786:Blood Glucose / Q000032:analysis; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009104:Multiple Trauma / Q000188:drug therapy*; D011188:Potassium / Q000097:blood; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D011188:Potassium; D008775:Methylprednisolone; D004837:Epinephrine