TS IEN OF PAT DS T EN STER OI EM CO AG RTIM AN CO ON PRESENTED BY: SUKESH KUMAR REG NO:0798083
INTRODUCTION Clinical application of corticosteroid Complication of corticosteroid Dental uses of corticosteroid Management of corticosteroid-use dental patients
Introduction Adrenal gland: Cortex and Medulla Adrenal cortex: 3-layer Outer: zona glomerulosa: Middle: zona fasciculata Inner: zona reticularis
Functions of corticosteroid Regulation of carbohydrate, fat, protein. Anti-inflammation action by inhibit lysosome, prostaglandin, cytokines release. Regulate the function of leukocyte. Increase gluconeogenic, proteolysis, lipolysis and blood sugar
Clinical application of steriod Immunosuppressive: Rheumatoid arthritis, SLE, organ transplantation, asthma… Anti-inflammation: hepatitis, dermatoses, mucositis, post-op edema… Analgesia: reduction of pain Replacement for adrenal insufficiency
Management of corticosteroid-use dental patients Prevent adrenal crisis
Adrenal crisis ( acute adrenal insufficiency) Hypotension Severe weakness Progressive mental confusion Nausea and vomiting Abdominal, lower back or leg pain Hyperthermia Hypoglycemia Hyperkalemia Improve CAD Loss of consciousness Coma death
Dental patient taking steroid supplementation not required Patient taking low dose (<20 mg of cortisol daily) Patient taking large dose: --for less than 2 weeks --for minor dental procedure with minimal stress
Dental patient taking steroid supplementation required Patient taking large dose: for greater than 2 weeks for extensive major or stressful dental procedure ＃ Double usual daily dose on the day before, the day of, and the day after surgery ＃ Appointment in the morning ＃ Good pain control ＃ Resume normal maintenance dose post-op 2 days.
Dental patient taking steroid supplementation required If the patient received at least 20mg of cortisol for more than 2 weeks within past year ＃ 60mg cortisol(or equivalent) the day before and the day of surgery at morning ＃ On first 2 post-op days, 40mg cortisol ＃ Then take 20mg cortisol thereafter, until post-op 6 days.
Management of adrenal crisis Place the patient in a supine position with leg elevated 200 mg hydrocortisone IV stat repeated as necessary Oxygen and CPR if necessary Transportation to a medical facility as soon as possible