ER visit vomiting diarrhea severe dehydration, increase pred?

[Mstiles]

hello everyone,

A week ago I woke up at night with severe vomiting for hours and diarrhea. Also chills and being cold. I eventually called 912 and was taken to the ER where they treated me. I had rapid heart rate a bit over 100 and they kept me until it went down. Not sure what caused it, food poisoning ruled out as family members who ate the same thing were not sick. I’ve been under a lot of family stress, an argument that night.

I’ve got multiple health issues that I’m trying to sort out. I posted not long ago about an increase in roaring tinnitus autophony if that could be GCA. Waiting to see a specialist about that. (Appointment in 3 months!) In the last few months I’ve had changes is left eye vision, no flashes or severe head pain. The far vision is just not crisp, somewhat blurry, like before cataract surgery. Talking to my Opthomologist about that. ER ordered a holster monitor and gastric tests.

My question is should I increase pred? I’m still stuck at 9mg. Still feeling tired and wobbly. Feeling overwhelmed by trying to figure everything out.

[agingfeminist]

My goodness you are coping with a lot. But you didn't mention any PMR symptoms. And 9mg is a bit high to be getting adrenal insufficiency symptoms...though others who are better informed might comment on this. Tired and wobbly perhaps is what to expect after all you have been through... probably the body crying out for rest and recuperation...a long time ago I remeber docs saying that people needed time to convalesce. I think that sometimes we don't give our bodies enough time to recuperate. Hope you feel netter soon.

[DorsetLady PMRGCAuk volunteer in reply to agingfeminist]

And 9mg is a bit high to be getting adrenal insufficiency symptoms

It is a bit higher than we normally suggest - but not impossible… especially with all the stress that  Mstiles has been under recently -

this from my “adrenals” post -

“WHAT HAPPENS WHEN YOU ARE ON STEROIDS?

The body normally makes approximately 30mg of cortisol per day although that is not necessarily a constant level, measurements of 300mg have been measured in patients undergoing surgery. 30mg of cortisol is approximately equivalent to 7.5mg of prednisone.

Once you have been on steroids for more than 2-3 weeks and at a dose higher than 7.5mg (which is roughly equivalent to the normal cortisol production by your Adrenals [does vary between 5-10mg, sometimes higher, for individuals] known as the physiological level they temporary stop working because the artificial cortisol in your body (Pred) means they don’t have to.

That means in a stressful situation where they would normally go into overdrive to help your body they don’t - that extra boost has already been superseded by the constant level the Pred gives (hope that makes sense) So you don’t get that extra burst of energy to help you out of a dangerous (stressful) situation - the fight or flight phenomena! Even on higher doses of Pred where perhaps you would not expect to feel fatigued or stressed you do, and that’s because you don’t get that extra “oomph.”

[PMRpro Ambassador in reply to agingfeminist]

If you are ill adrenal insufficiency may manifest - the adrenals would normally produce extra cortisol to help the body cope with the extra stresses but they can't, that response is damped. So the effect of illness on the body may be far greater than you would normally expect. And that is the role of sick day rules in the shorter term.

[Golf-1]

I have had those two very severe symptoms at the same time twice this year.

The first in January when on 6mg Pred - I woke up with stomach pains at about 3.00 managed to get to the loo and spent the next 2 hours either sitting on it or with my head over it retching. I had a very sore stomach for the next 5 days and lost around 12 pounds in weight through not eating.

The second was about 5 weeks ago when I had just started the slow taper from 5 - 4.5mg of Pred. On this occassion both were happening at the same time - not nice !!!! again I had a very sore stomach for several days after.

I had assumed both were caused by food poisoning although could not identify which food it might have been.

Having read this post, I am now wondering if there is any relation between these symptoms and my medication Prednisolon and Methotrexate ???????

[PMRpro Ambassador in reply to Golf-1]

I experienced similar problems very intermittently for several years - long before PMR and was on no medication at all. You could practically set a clock - the first "stirrings" were about 2.45am, once my gut was thoroughly emptied I felt appallingly weak and could do nothing but sleep for a few hours after which I felt very delicate and wobbly but no nausea. I, too, assumed it was food poisoning but the timing wasn't really right and difficult to identify a culprit.

Eventually I narrowed it down to POSSIBLY something in heavier red wines but still difficult to say more than that. My GP referred me to the local allergy specialist and she was of the opinion it was absolutely typical of a food allergy because of the timing and the effects but it was impossible to say exactly what, we could test until kingdom come and still not find the answer,

Her solution was very simple - take an antihistamine before eating anything that could be a culprit! I stocked up on cheap loratidine from Lidl (other suppliers are available, rarely as cheaply though!) and took it regularly for a few years - and never had a repeat. Might have been coincidence but when I tried NOT taking it daily it happened again. Then one night it occurred to me to take an antihistamine tablet as soon as I woke - there was usually a good half hour before the vomiting started. And it worked - it didn't progress in the usual pattern. That an antihistamine aborted the event suggests it wasn't food poisoning and I have continued to take loratidine as required rather than every day and the problem seems solved.

[Golf-1 in reply to PMRpro]

That is very interesting, probably nothing to do with PMR, Pred or MTX then ?

I am a fan of red wine so will see if/when it happens again, if wine is the culprit. I would rather not take even more pills, but I do not want those symptoms if they can be avoided

[PMRpro Ambassador in reply to Golf-1]

I think I'd use the word POSSIBLY not but it is very difficult to be certain. We weren't entirely but trying antihistamines was easy, cheap and not going to cause any harm. If it is possible to identify the cause for certain that is one thing - but even then, it may involve a medication of some sort.

[Golf-1 in reply to PMRpro]

Thank you, I have antihistermine in the house already, so will move it nearer my bed just in case, I will also look out for the Lidl alternative for future possible use.