Corticosteroids are the drug that saves the patient and then slowly takes them apart. Every long-term effect traces back to one idea — too much cortisol, for too long — and the taper exists because the body has stopped making its own. Tap the body to explore the damage, then drag the taper.
Where the damage lands
Eleven long-term effectstap the body or a row to begin
STEROIDS — Sugar (hyperglycemia) · Thin skin & truncal obesity · Emotional lability · Reduced immunity · Osteoporosis · Increased BP · Dyspepsia & ulcers · Sleep loss + Suppression of the HPA axis.
Abrupt stop—12 weeks
Lowest total—
Days below crisis line—
Verdict—
Adrenal crisis — the emergency you are preventing. Profound weakness, nausea and vomiting, abdominal pain, dizziness, hypotension progressing to shock, hypoglycemia, hyponatremia, fever. Treatment is IV hydrocortisone plus IV 0.9% sodium chloride with dextrose. Hydrocortisone is the steroid of choice here because it carries mineralocorticoid activity as well.
Sick-day / stress dosing. A suppressed axis cannot surge cortisol for illness, injury, or surgery. Teach the patient: fever, vomiting, or a procedure means call before you skip a dose — the dose usually goes up, not down. Vomiting means the oral dose did not land: that patient needs parenteral steroid. Every one of these patients carries medical-alert identification.