Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Do Numbness And Tingling In Arms And Hands After Using Prednisone Indicate?
Question: My wife is a 37 year old woman, 5'4", 170# 1 year after pregnancy, 7 years post-bilateral-lung-transplant from end-stage lung disease from cystic fibrosis. Long term meds include Rapamune 3mg daily, Prograf 3mg 2xDaily, Prednisone 5mg daily, Aspirin 81mg daily, Azithromycin 250mg every other day (prophylactic use shown beneficial in post-tx), Metoprolol 50mg morning/25mg evening, Alphagan 1 drop/eye twice a day, Advair 250/50 daily, Nexium daily, Flonase 4mcg daily, Insulin w/ meals (1 unit / 7-8g carbs). Currently also on Cayston inhaled antibiotic as part of every other month prophylactic treatment for cystic fibrosis and post-tx.
She recently contracted what is likely a cold and was prescribed a prednisone boost of 40 mg a day (to taper in two days increments). Today she took her normal 5 mg in the morning, and the first of her 40 mg boosts this afternoon shortly before dinner. She is now experiencing numbness and tingling in her arms and hands and see that it is a symptom that should prompt an immediate call to her doctor. However, as it's 2am, I'm wondering if this means "immediate or page or 9-1-1 call" severity, or if it can wait until the morning to notify the doctor. And what is the reason that numbness prompts such urgency with prednisone? What's the possible mechanism at work that requires such emergent action?
She recently contracted what is likely a cold and was prescribed a prednisone boost of 40 mg a day (to taper in two days increments). Today she took her normal 5 mg in the morning, and the first of her 40 mg boosts this afternoon shortly before dinner. She is now experiencing numbness and tingling in her arms and hands and see that it is a symptom that should prompt an immediate call to her doctor. However, as it's 2am, I'm wondering if this means "immediate or page or 9-1-1 call" severity, or if it can wait until the morning to notify the doctor. And what is the reason that numbness prompts such urgency with prednisone? What's the possible mechanism at work that requires such emergent action?
Brief Answer:
Its seems to be due to Prednisone fast titration
Detailed Answer:
I welcome you here at my Virtual Clinic Mr. XXXX!
I can realize the health worries of your wife. Don't worry, I will take care of it.
She is otherwise doing very good, she is a very compliant patient. These signa of numbness and tingling sensations seems to be due to prednisone. High doses sometimes cause numbness and tingling sensations in legs, arms and hands.
If she has a low Mineral levels, Calcium and Potassium, that also augments this problem when taken prednisone in high doses.
Prednisone also raises blood sugar levels and blood pressure.
I suggest you to stay home. Its not looking like an emergency. Schedule the early morning appointment with her physician. But keep an eye on her uptil then.
Her physician will first do her physical examination and will check any signs of allergic reaction, muscle strength in legs, arms and hands. Different sensations of the limbs will be assessed.
He is trained to handle such issues.
He may run a battery of tests on her like her blood sugar levels, blood mineral levels e.g potassium and calcium. Her thyroid profile is necessary to be worked up. He will give you a detailed care with all of this.
I hope, she gets very well soon. In future if you have any health issues at your household, you may directly go my profile and click at " ask me a question" for a direct, and prompt response with medical care right in your inbox. Please don't forget to give your valuable positive feedback and 5star rating so that I may be in a better position to assist you in a better way in future too.
Regards!
Your family physician
Dr. Hanif XXXXXXX , USA
Its seems to be due to Prednisone fast titration
Detailed Answer:
I welcome you here at my Virtual Clinic Mr. XXXX!
I can realize the health worries of your wife. Don't worry, I will take care of it.
She is otherwise doing very good, she is a very compliant patient. These signa of numbness and tingling sensations seems to be due to prednisone. High doses sometimes cause numbness and tingling sensations in legs, arms and hands.
If she has a low Mineral levels, Calcium and Potassium, that also augments this problem when taken prednisone in high doses.
Prednisone also raises blood sugar levels and blood pressure.
I suggest you to stay home. Its not looking like an emergency. Schedule the early morning appointment with her physician. But keep an eye on her uptil then.
Her physician will first do her physical examination and will check any signs of allergic reaction, muscle strength in legs, arms and hands. Different sensations of the limbs will be assessed.
He is trained to handle such issues.
He may run a battery of tests on her like her blood sugar levels, blood mineral levels e.g potassium and calcium. Her thyroid profile is necessary to be worked up. He will give you a detailed care with all of this.
I hope, she gets very well soon. In future if you have any health issues at your household, you may directly go my profile and click at " ask me a question" for a direct, and prompt response with medical care right in your inbox. Please don't forget to give your valuable positive feedback and 5star rating so that I may be in a better position to assist you in a better way in future too.
Regards!
Your family physician
Dr. Hanif XXXXXXX , USA
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks for the reply.
I'm well aware that hypocalcemia or hypokalemia can cause cardiac problems, and did wonder if that was part of the warning, especially since heartbeat irregularities were also mentioned as an emergent side effect.
However, I'm curious - what's the mechanism at work? Does it act as a chelation agent? Does it inhibit absorption? (Of course part of me is curious if we could've addressed it by eating a banana milkshake.) And since I could only find reference of numbness with long-term prednisone use, my wife's case is especially interesting since she -is- on a long-term very low dose of 5 mg daily -- but has never seen this effect -- until experienced during a steroid bolus of 40 mg daily for only two days.
I'm well aware that hypocalcemia or hypokalemia can cause cardiac problems, and did wonder if that was part of the warning, especially since heartbeat irregularities were also mentioned as an emergent side effect.
However, I'm curious - what's the mechanism at work? Does it act as a chelation agent? Does it inhibit absorption? (Of course part of me is curious if we could've addressed it by eating a banana milkshake.) And since I could only find reference of numbness with long-term prednisone use, my wife's case is especially interesting since she -is- on a long-term very low dose of 5 mg daily -- but has never seen this effect -- until experienced during a steroid bolus of 40 mg daily for only two days.
Brief Answer:
I will extrapolate my help towards all the issues and their route causes.
Detailed Answer:
I warmly Welcome you back Mr. XXXXXXX dun!
I appreciate your cooperation. The cardiovascular effects due to Steroid use are mostly due to anabolic steroid abuse and takes time to kick in and involves (MAO) an enzyme inhibition, increasing LDL (bad) cholesterol and decreasing HDL (good) cholesterol (i.e that goes to the level of genes and proteins and takes time for cardiovascular signs/symptoms to start). So, numbness and tingling sensations are altogether a different issue which has neither such a major correlation, nor a warning sign to cardiac hazards. But still we need to keep an eye on mineral levels in body.
For every drug effect in the body, there is a bodily defined specific plasma concentration needed, and once that concentration is reached, drug shows its effects. Same is true with side effects too. Drug has to overwhelm the bodily clearing processes to overcome the normal systems, and show adverse reactions. Acute allergic reactions have a different story though.
She is taking many different drugs. Advair (Fluticasone + Salmeterol) once again contains a steroid 250 mg fluticasone. Also Fluticasone causes significant hyperglycemia, another cause of paresthesias in diabetics on steroids. Moreover, Salmeterol causes significant hyperglycemia.
She is on Flonase (Fluticasone) again steroid, and same aforementioned consequences.
5 mg steroid, she is already on. and a dose of 40 mg incremental also added to the steroid load on body.
Prednisone and aspirin cause significant interaction through a process called pharmacodynamic synergism, where they enhance the effects of each other.
She is on insulin. Diabetes itself causes damaged peripheral sensations by affecting the nerves. Acute exacerbations are typically seen clinically in patients on high corticosteroids in blood.
Metoprolol also causes paresthesias in fingers, hands and feet.
Chelation had nothing to do with all the cumulative scenario we have, and it works well for the time, the poison is still in stomach and isn't absorbed yet. Raw banana is more effective than milkshake, for some poisons.
Hope it helped you today. If you need further, detailed and quick assistance related to any health issues, feel free to 'ask me a question' directly from my profile.
You can also attach Lab reports and pictures directly from the question window, or by emailing it to YYYY@YYYY with the Subject as, Attention: Dr. Muhammad Hanif, and the lab reports and images will directly reach my inbox for review.
May you get very well soon and have a wonderful time ahead. Please don't forget to give your valuable feedback and five star rating, to help me assist you in a better way in future too. Please, write a review about your experience with me.
Regards!
DR. HANIF XXXXXXX USA
I will extrapolate my help towards all the issues and their route causes.
Detailed Answer:
I warmly Welcome you back Mr. XXXXXXX dun!
I appreciate your cooperation. The cardiovascular effects due to Steroid use are mostly due to anabolic steroid abuse and takes time to kick in and involves (MAO) an enzyme inhibition, increasing LDL (bad) cholesterol and decreasing HDL (good) cholesterol (i.e that goes to the level of genes and proteins and takes time for cardiovascular signs/symptoms to start). So, numbness and tingling sensations are altogether a different issue which has neither such a major correlation, nor a warning sign to cardiac hazards. But still we need to keep an eye on mineral levels in body.
For every drug effect in the body, there is a bodily defined specific plasma concentration needed, and once that concentration is reached, drug shows its effects. Same is true with side effects too. Drug has to overwhelm the bodily clearing processes to overcome the normal systems, and show adverse reactions. Acute allergic reactions have a different story though.
She is taking many different drugs. Advair (Fluticasone + Salmeterol) once again contains a steroid 250 mg fluticasone. Also Fluticasone causes significant hyperglycemia, another cause of paresthesias in diabetics on steroids. Moreover, Salmeterol causes significant hyperglycemia.
She is on Flonase (Fluticasone) again steroid, and same aforementioned consequences.
5 mg steroid, she is already on. and a dose of 40 mg incremental also added to the steroid load on body.
Prednisone and aspirin cause significant interaction through a process called pharmacodynamic synergism, where they enhance the effects of each other.
She is on insulin. Diabetes itself causes damaged peripheral sensations by affecting the nerves. Acute exacerbations are typically seen clinically in patients on high corticosteroids in blood.
Metoprolol also causes paresthesias in fingers, hands and feet.
Chelation had nothing to do with all the cumulative scenario we have, and it works well for the time, the poison is still in stomach and isn't absorbed yet. Raw banana is more effective than milkshake, for some poisons.
Hope it helped you today. If you need further, detailed and quick assistance related to any health issues, feel free to 'ask me a question' directly from my profile.
You can also attach Lab reports and pictures directly from the question window, or by emailing it to YYYY@YYYY with the Subject as, Attention: Dr. Muhammad Hanif, and the lab reports and images will directly reach my inbox for review.
May you get very well soon and have a wonderful time ahead. Please don't forget to give your valuable feedback and five star rating, to help me assist you in a better way in future too. Please, write a review about your experience with me.
Regards!
DR. HANIF XXXXXXX USA
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you very much for the additional detail - it's much appreciated!
So if I can recap to ensure I understand - it's not so much that the steroid use or bolus steroid dose caused numbness/tingling pointing to potential low mineral or cardiac issues. Rather, in her case, it's more likely that with the combination of all the meds and doses, there were multiple reasons/causes possible for the paresthesia, which may or may not have signaled emergent cardiac concerns.
Having said that, had the paresthesia been more prolonged or significant, because of the multiple possible causes behind it, it would be wise to notify her doctor or seek out an emergency room because of the risk of any number of critical systems being affected.
So if I can recap to ensure I understand - it's not so much that the steroid use or bolus steroid dose caused numbness/tingling pointing to potential low mineral or cardiac issues. Rather, in her case, it's more likely that with the combination of all the meds and doses, there were multiple reasons/causes possible for the paresthesia, which may or may not have signaled emergent cardiac concerns.
Having said that, had the paresthesia been more prolonged or significant, because of the multiple possible causes behind it, it would be wise to notify her doctor or seek out an emergency room because of the risk of any number of critical systems being affected.
Brief Answer:
Yes, notify her treating physician.
Detailed Answer:
I welcome you back!
Yes you are right. You got my point. And now, please make an appointment and consult her physicain right away to assess any risks. It's not an Emergency though because its natural course of her diseases processes too.
Her physician will examine her physically to assess the level of paresthesia and any associated issues with motor system ( if any).
He will run a battery of tests, like HBA1c (glycated Hemoglobin), serum electrolytes, Complete metabolic profile, just to list some.
If you need further, detailed and quick assistance related to any health issues, feel free to 'ask me a question' directly from my profile. You can also attach Lab reports and pictures with direct question.
May she get very well soon and have a wonderful time ahead. Please don't forget to give your valuable feedback and five star rating, to help me assist you in a better way. Please, write a review about your experience with me.
Regards!
DR. HANIF
XXXXXXX USA
Yes, notify her treating physician.
Detailed Answer:
I welcome you back!
Yes you are right. You got my point. And now, please make an appointment and consult her physicain right away to assess any risks. It's not an Emergency though because its natural course of her diseases processes too.
Her physician will examine her physically to assess the level of paresthesia and any associated issues with motor system ( if any).
He will run a battery of tests, like HBA1c (glycated Hemoglobin), serum electrolytes, Complete metabolic profile, just to list some.
If you need further, detailed and quick assistance related to any health issues, feel free to 'ask me a question' directly from my profile. You can also attach Lab reports and pictures with direct question.
May she get very well soon and have a wonderful time ahead. Please don't forget to give your valuable feedback and five star rating, to help me assist you in a better way. Please, write a review about your experience with me.
Regards!
DR. HANIF
XXXXXXX USA
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
