Fluid and Electrolyte Disturbances

The normal subject may retain sodium and water during steroid therapy, although the synthetic steroid ana logues represent a lesser risk in this regard. Prednisolone produces some edema in doses greater than 30 mg; triamcinolone and dexamethasone are much less liable to elicit this effect. Glucocorticoids may also produce an increase in potassium excretion. Muscle weakness and wasting of skeletal muscle mass frequently accompany this potassium-depleting action. The expansion of the extracellular fluid volume produced by steroids is secondary to sodium and water retention. However, the presence of specific steroid receptors in vascular smooth muscle suggests that glucocorticoids are also more directly involved in the regulation of blood pressure. The major adverse effects of glucocorti-coids on the cardiovascular system include dyslipidemia and hypertension, which may predispose patients to coronary artery disease. A separate entity, steroid myopathy, is also improved by decreasing steroid dosage.

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