Cerebral edema from brain tumor

Posted On January 31, 2023
  • Steroid may be given po or iv
    • Currently not on steroid
      • Dexamethasone 10 mg iv
      • then 4 mg q 6 hour
    • Already on steroid
      • Increase Dexamethaxone 4 mg/day
    • Signs of impending herniation
      • decreased LOC, new 3rd nerve palsy
        • Dexamethasone 10 mg iv load
        • then 4 to 10 mg q 6 iv
        • ivu care
        • consider
          • Mannitol: 1 g/kg iv bolus, then 0.25 – 0.5 gram/kg q6 hours
          • Hypertonic saline: 3% infusion by central line 50-150 ml/hr, goal Na 145-155
          • HYperventilation: PaCO2 to 26-30 mmHg
    • If improved after a few days
      • gradual taper
    • No improvement
      • Increase further
        • up to 16 mg/day
  • Monitor for
    • oral thrush, gastritis
    • hyperglycemia
    • myopathy
    • weight gain, bone loss