In the treatment of flares of inflammatory bowel disease, intravenous hydrocortisone causes greater falls in blood potassium and more severe episodes of hypokalaemia than methylprednisolone

Abstract

Introduction Corticosteroids are important treatments for acute exacerbations of infl ammatory bowel disease (IBD). In severe fl ares, or when oral steroid has proven unsuccessful, high dose intravenous steroid can be given in a hospital setting. Two intravenous corticosteroids are in common usage: hydrocortisone (HC) and methylprednisolone (MP). As well as the therapeutic glucocorticoid effect, both agents have mineralocorticoid effect. The mineralocorticoid effect of HC is greater than MP at the doses commonly used. It has been noted that high dose HC can cause life threatening hypokalaemia. To the authors' knowledge, the effects of MP and HC on serum potassium levels have not been assessed for a group of patients being treated for fl ares of IBD. Methods The case notes of patients with IBD were studied and details of admissions requiring intravenous steroid were noted. Blood potassium (K) levels on admission and throughout the inpatient stay were recorded. Disease extent and severity on admission was noted. Length of admission, length of steroid course, and whether the patient had surgical intervention or started ciclosporin or biologic therapy was also noted.

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

“…Intravenous corticosteroids such as hydrocortisone 100 mg four times daily or methylprednisolone 60 mg every 24 hours are the cornerstone of treatment of ASUC 106 203–205. Methylprednisolone has less mineralocorticoid effect than hydrocortisone at these doses and so causes significantly less hypokalaemia 206. There is no real advantage from giving higher doses and a bolus injection is as effective as a continuous infusion 207.…”

A comparison of intravenous methylprednisolone and hydrocortisone for the treatment of acute inflammatory bowel disease

“…This is slightly higher than Wiles et al, who reported a rate of 45% (76/170 patients). 14 Of note, they described marked differences in incidence of patients treated with IVHC vs IVMP (69% vs 11%, P < 0.0001), with similar rates of requirement for potassium supplementation. Our data also demonstrated this (67% vs 56%, P = 0.04, respectively) and IVMP was shown to be an independent predictor of reduced hypokalemia OR = 0.49, P = 0.005.…”

“…13 IVHC use in acute severe colitis has been shown to have an increased incidence of hypokalemia compared with IVMP. 14 Hypokalemia is known to predispose to colonic dilatation. 15 Additionally, it has the practical benefit of a once daily dosing regimen, which has been shown to be no different than continuous infusions in terms of efficacy and safety in acute severe UC.…”

“…6 Despite this, only one study has directly compared their use and outcomes. 14 Within Auckland, New Zealand, there are differences in prescribing protocols between the three tertiary hospitals. The aim of this study was to compare the two most commonly used regimens of IVHC 100 mg 6 hourly to IVMP 60 mg daily in the treatment of an acute flare of IBD, with regard to differences in length of stay, duration of IVCS, requirement for rescue biologics or cyclosporin use, 30-day bowel resection rate and hypokalemia effect.…”

Management of Acute Severe Colitis in the Era of Biologicals and Small Molecules

“…There is no additional benefit for higher doses than methylprednisolone 60 mg/day beyond 7-10 days of therapy as it may actually increase complications risk. Hydrocortisone (100 mg every 6 h) has been associated with higher rates of hypokalaemia [36].…”