Decadron burned my patients crotch?

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migm

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Anyone ever hear of this? I was treating migraine. 10mg IV decadron, given alongside benadryl and reglan as well as gram of mag. After receiving all of those meds (and of the course the headache didn't improve), upon receiving the decadron the patient apparently sat bolt upright and complained of severe burning in the crotch region. What gives? is there an explanation for this?
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Absolutely very common. Ask the rn to give it slow. I don't know the pathophys. If you can give it oral, do.

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shoal007 said:
Absolutely very common. Ask the rn to give it slow. I don't know the pathophys. If you can give it oral, do.

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very common if given to fast - I have no idea of the mechanism of it - but specific for perianal burning - anything over 10 should be put in a minibag and administered over 15 minutes - you can push 10, but I always tell the RN's to give it slowly
 
A nurse mentioned this to me about a week or two ago as being a thing. Never heard of it before
 
It's usually peri-anal burning/itching (which most patients are going to call their junk anyway) when given too rapidly. IV dex needs to be given in a very slow IV push, or in a 25ml drip over 20-30 minutes. Our (oncology clinic) RNs will do it one way or the other depending on how busy they are and whether or not they have time to sit bedside for 10+ minutes for the slow IV push.
 
Definitely a "thing" -- perianal burning directly related to rate of administration.

Causes the ring of fire, as it were.

I've asked around as far as the mechanism. Nobody has ever been able to give me one, including our most experienced ED pharmacists. If anyone can teach us all, that would be awesome.
 
Veil said:
Definitely a "thing" -- perianal burning directly related to rate of administration.

Causes the ring of fire, as it were.

I've asked around as far as the mechanism. Nobody has ever been able to give me one, including our most experienced ED pharmacists. If anyone can teach us all, that would be awesome.
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No clue. I've asked half a dozen different oncology pharmacists (including the current head of pharmacy at NCI) and nobody can explain it.
 
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Veil said:
Definitely a "thing" -- perianal burning directly related to rate of administration.

Causes the ring of fire, as it were.

I've asked around as far as the mechanism. Nobody has ever been able to give me one, including our most experienced ED pharmacists. If anyone can teach us all, that would be awesome.
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. I am a ed Rph. Basically no one knows why. Thought was it is relared to the phosphate ester. But that is just a guess because that is what differentiates decadron from
Other steroids that don't have the side effect.
 
I had a pt note itching if her scalp after 10mg iv dex last week..
 
Perineal itching due to dex is a side effect well known to anesthesiologists. We give dex on induction, never awake.
 
TooMuchResearch said:
Maybe we don't note it often because our patients are distracted by severe respiratory distress?

I don't typically use IV decadron for headaches, tend to do PO if I'm using it.

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Yeah. It's worth noting that decadron for headache has only been found to decrease recurrence rates. As such, there's not a whole lot of reason to give it as an IV push, and only rarely is there a need to give it IV.
 
4 years of residency where I just used 10mg dex for EVERY THING I never saw it. 3 months of practice where I use it somewhat less often and I've seen it twice.

Difference? Residency had P.O. dex and current shop only has IV dex in the ED (and convincing nurses to let the patient drink the IV solution is just way too complicated). It really does seem to be an IV only issue.
 
DocEspana said:
4 years of residency where I just used 10mg dex for EVERY THING I never saw it. 3 months of practice where I use it somewhat less often and I've seen it twice.

Difference? Residency had P.O. dex and current shop only has IV dex in the ED (and convincing nurses to let the patient drink the IV solution is just way too complicated). It really does seem to be an IV only issue.
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That's too bad. I give the IV form of dex PO for croupy kids, because I've been told that the IV form tastes better than the PO form. I've never known a nurse to have a problem with it.
 
WilcoWorld said:
That's too bad. I give the IV form of dex PO for croupy kids, because I've been told that the IV form tastes better than the PO form. I've never known a nurse to have a problem with it.
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Yeah. Last shop didn't actually have a po dex, but it had a "give po" button. Now I'm using meditech and making that same order appear involves too many clicks, a call from pharmacy every single time, and a nurse asking me if I meant to do that every single time
 
DocEspana said:
Yeah. Last shop didn't actually have a po dex, but it had a "give po" button. Now I'm using meditech and making that same order appear involves too many clicks, a call from pharmacy every single time, and a nurse asking me if I meant to do that every single time
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Arggg.
 
WilcoWorld said:
That's too bad. I give the IV form of dex PO for croupy kids, because I've been told that the IV form tastes better than the PO form. I've never known a nurse to have a problem with it.
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Must be somewhat common, local ED did that with my kid last week.
 
How am I just learning about this now. All my nurses already knew this. I'm just thinking of all the possibilities now when I need to use this!:idea:
 
WilcoWorld said:
That's too bad. I give the IV form of dex PO for croupy kids, because I've been told that the IV form tastes better than the PO form. I've never known a nurse to have a problem with it.
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The liquid form also had a high concentration of alcohol - although you can argue if giving a kid the equivalent of a shot of whiskey is bad or not.
 
It's real. So real, in fact, that while on my anesthesia rotation at a children's hospital, I noticed when I pushed decadron AFTER induction/tube, kids' HR would spike and sometimes they'd even start bucking. The way they behaved under GA made it seem like the effect is almost as irritating as surgical stimulation.
 
Why do I feel that after this thread we are going to start seeing reports about decadron becoming the next hot street drug?
 
Vandalia said:
Why do I feel that after this thread we are going to start seeing reports about decadron becoming the next hot street drug?
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For that to happen, decadron would have to do things to the crotch, other than burning it.
 
Birdstrike said:
For that to happen, decadron would have to do things to the crotch, other than burning it.
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You are giving an awful lot of credit to the ability of a certain segment of our population to accurately interpret the reported effects of drugs. I have seen more than enough people pass through to prove the opposite. A while back I had a mom bring her son in after he ingested several of his grandfather's losartan tablets. The boy said he tried them after his grandfather reported feeling "woozy" after starting the med.
 
as someone mentioned earlier -- phosphate esters

"The pharmacological mechanism explaining this phenomenon remains poorly understood, but could be related to the phosphate ester of the corticosteroid since perineal irritation has been described with hydrocortisone-21-phosphate sodium and prednisolone phosphate [11,12]. No detailed explanation is mentioned even on extensive medline search. It has been explained that the pathogenesis of perineal pruritus /pain has been may be related to corticosteroid phosphate esters such as the dexamethasone sodium phosphate (as used in our cases) to cause perineal pain and irritation. Both the incidence and severity may increase as the organic phosphate content of the injection increases. The lesser duration of pain might be due to hydrolysis of compound to phosphate ions and dexamethasone. However, the pathophysiology of this rare side-effect still remains unknown and further research is required.
Fortunately, this adverse effect diminishes on its own as the compound is hydrolyzed and it has not produced any postoperative prolonged effect."

Intravenous Dexamethasone Causes Perineal Pain and Pruritus
 
I had never seen this until the past week where it has happened twice, and I knew exactly what it was thanks to this thread haha. The second time I was talking to the patient when it happened and fwiw the nurse slammed, giving 10mg in about half a second, it started within 5 or 10 seconds and was over within 30.
 
Jlaw said:
I had never seen this until the past week where it has happened twice, and I knew exactly what it was thanks to this thread haha. The second time I was talking to the patient when it happened and fwiw the nurse slammed, giving 10mg in about half a second, it started within 5 or 10 seconds and was over within 30.
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Was this that nurses first shift out of school? Even nursing students are taught this.
 
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