MosaicED Brain Teaser!
It's a Monday morning and you're sitting in a rural ED dreaming of being in that place where they made those Corona ads. A 10 year old boy is brought in with puffy eyes and leg oedema. His urine is dark and frothy and his parents report that he has been tired all weekend. You make the diagnosis and treat him.
Whilst you administer several drugs, this question concerns the drug that treats the underlying pathology. Which of these is not a short term adverse effect of that drug?
- A-Fluid retention
D-Osteoporosis. There are several parts to this question, the first is identify that the patient is has nephrotic syndrome, most likely minimal change disease as he is 10. A urine dipstick will show proteinuria >3+. It is treated with steroids but management would also include supplementing the albumin he lost, aspirin (for anticoagulation, protein loss can mess with coagulation), benpen for prophylaxis, a low salt diet , patient and parent education, furosemide (to get rid of excess fluid), gastroprotection,, hospitalization, and giving immunizations (flu and pneumococcus). The steroid you would use is prednisolone. It is has many side effects, in the short term the ones your should know are; psychosis, fluid retention, immunodeficiency (infections), hyperglycemia. In the long term the main ones are; psychosis (if stopped suddenly), GI bleeding, Cushing's syndrome, osteoporosis, and osteonecrosis. Osteoperosis is not a short term side effect of prednisolone treatment.