Help please - Pred dose after vomiting

[Jbobby]

I’ve had a night of violent vomiting and diarrhea. Not sure where it came from but think it’s possibly a bacterial infection that has been lurking and waiting to come out for some time. I had been struggling with lowering dose and feeling pain all over body. The pain stiffness symptoms seemed to Co-incide roughly with when I tried to go down to 6mg, since when I’ve been adding to my dose and yesterday was on 12mg. I took 9.5 around 11am and a further 2.5 at around 10pm to try help me through the night. I then started vomiting violently at around 11pm and all through night. Plus diarrhoea. I assume my body is now devoid of Pred and wondered what to do as I don’t feel my stomach cd take much right now, let alone a dose of vicious Pred. Besides which I’m on E/C Pred which I always take with yogurt or kefir and they seem to take sone time to work. (So I’m not on PPI’s although I have a stash of non e/c pres somewhere in case ever needed) . However I’m concerned about Adrenal crisis and Wd welcome advice asap . Thank you

[DorsetLady PMRGCAuk volunteer]

Sorry to hear this… if you can find the plain Pred perhaps try crushing a tablet and adding to a small spoon of yogurt and see if you can keep that down.. even if only a tiny bit at a time.

You so need to keep well hydrated - so plenty of fluids if you can that as well..

[Jbobby in reply to DorsetLady]

Thank you DL… Dyou think I should take the dose I wd normally be at (I.e. 10-12mg) or is 5mg enough to keep things ok until I feel I can eat more normally?

[DorsetLady PMRGCAuk volunteer in reply to Jbobby]

Agree with PMRpro -but you could try 5mg now (or soonish) and then another 5mg in another few hours..

[Jbobby in reply to DorsetLady]

Thank you DL. I fell asleep since last looking at posts so going to try now … and see how it goes

[DorsetLady PMRGCAuk volunteer in reply to Jbobby]

Well at least reading posts did some good.💤 😊

[Jbobby in reply to DorsetLady]

Exactly! 😮‍💨

[PMRpro Ambassador]

If you can take the plain pred as DL suggests, you only need to keep it down for about an hour for it to be absorbed and 5mg would be better than nothing, but more would be better. But if you feel worse or the D&V goes on much longer so you can't keep fluids down you need medical advice both on the pred front and re hydration problems.

Once the pred is absorbed, the vomiting won't deplete the pred levels in your body but it does fall to a very low level over a period of just under 24 hours. And the D&V may make you feel very ropey without a new supply of cortisol or pred. So don't discount that problem if you continue to feel really unwell and be firm with the practice when seeking help. If they are dismissive, don't hesitate to call 999 and be clear about being a longterm steroid patient.

[Jbobby in reply to PMRpro]

Thanks so much PMRpro. Am currently drinking warm tea (without milk) with a bit of honey, ginger and salt sprinkled in and lots of water. So far so good and I’m not vomiting and havnt done for about 4 hours. So think I’ll try crushing 10mg ordinary Pred into yogurt in an hour or so and see how that goes. If all goes haywire I’ll get in touch with local doc…Meantime many thanks again.

[Jbobby in reply to PMRpro]

Interestingly , since last night I’ve not felt any of the pain and stiffness I’ve been feeling over last 2/3 weeks ( and that’s before taking Pred today). I also had extreme pain on right side for last two or three days which I now recognise as being liver pain and which has also disappeared since last night. I’m wondering if I was suffering from a ‘fatty liver’ and dinner yesterday just tipped it over the edge and liver said ‘I’ve had enough’! But more to the point, Dyou think it cd have been a bacterial infection that was festering in my system for some time ( I believer that can happen) and that was affecting the rest of my body and bringing on a lot of stiffness and PMR ish symptoms.?

[PMRpro Ambassador in reply to Jbobby]

Could it have been biliary colic last night?

nhs.uk/conditions/gallstone...

Any other symptoms?

[Jbobby in reply to PMRpro]

Possibly , although the pain in my liver/right side was going on for much longer than 1-5 hours. It felt like a gradual build up of fatty foods which is not sobering I usually eat but had done so a little more recently partly coz of the cold weather. I’m usually on a pretty anti inflammatory diet - fish, veg, chicken, eggs, olive oil etc. along with sheep/goat yogurt etc so maybe it was a bit of a shock to the system. Anyway after an hour of crushed Pred I’m feeling ok-ish. Just exhausted. But as I said, no pain in body this morning post vomiting which is interesting….🤔

[PMRpro Ambassador in reply to Jbobby]

Yes - I did a bit of reading round and it does seem to suggest that you can have a gradual build up that then becomes acute as yours did and beforehand you may not realise what you are feeling. I think you ought to try to get a GP to investigate a bit - and have you actually been TOLD you have "fatty liver"?

[Jbobby in reply to PMRpro]

No I havnt been told that but it was just my instinct that I’d recently overloaded my liver with unusually fatty food - beef etc. And I had painful right side for last 2 to 3 days ( on top of the pain and stiffness I’ve had for last 2 weeks) which has now completely disappeared.

[PMRpro Ambassador in reply to Jbobby]

That isn't how fatty liver works really - and what you describe could fit with gall bladder issues. So worth speaking to your doctor.

[Jbobby in reply to PMRpro]

Ah ok. Perhaps I mean liver overload! Anyway thank you, I’ll speak to doc about it.

[DorsetLady PMRGCAuk volunteer]

How are you feeling this evening? Better, I hope.

[Jbobby in reply to DorsetLady]

Oh thank you so much for asking DL, yes I definitely feel better this evening having had rest and lots of liquids.

[DorsetLady PMRGCAuk volunteer in reply to Jbobby]

Good to hear -hope you continue to improve…

[Jbobby in reply to DorsetLady]

Thank you DL. 🙏

[ChrisBeeLoop]

I experienced four of five apparently random bouts of severe diahorrea and vomiting over the course of about nine months. Finally I talked to my GP about it and after various tests blood tests they found my kidney function was looking grim, very high creatinine levels. The GP immediately took me off Omeprazole which, fingers crossed, seems to have solved the problem. May be a complete red herring but I guess blood test are a good start.

[Jbobby in reply to ChrisBeeLoop]

Thanks so much ChrisBeeLoop… I’m so sorry you had that experience but interesting to hear. Actually I’m not on PPI’s at moment coz I’m taking E/C Pred but still I think my body was rebelling against an overload of something. Am also going to look into possible gallbladder probs as recommended by PMRpro. I hope all is good for you going forward…🤞🏼

[Oh-my]

When I had the norovirus over Christmas and couldn't keep anything down my GP surgery told me I could take pred dispersed in 100mls of water and to sip it slowly over a 5 minute period. It tastes horrible and okay to do this on the stomach as a once off if you can't manage food. I too was very worried about missing pred doses.

[Jbobby in reply to Oh-my]

Thank you Oh My… actually I was about to ask the question: is it ok in general to take ground up ordinary Pred in water or yoghurt, say, on longer term usage without PPi’s .? As I normally take e/c Pred I’m not in PPi’s…

[Oh-my in reply to Jbobby]

It was only meant as a once off or very short duration of time - until I could keep food down. I imagine if you have been prescibed e/c pred, it's for a reason. Having pred dispersed in water (although kinder on the stomach than taking it whole) would not stop it avoiding your stomach, even if taken with food too. If you don't need e/c or PPi's then dispersing it is fine (taken with or after food) but the taste is terrible.

[Jbobby in reply to Oh-my]

Ok. Thanks very much Oh My…