Omeprazole IV while on prednisone IV?

[Cucurbita]

Hello,

I was hospitalized yesterday (due mainly to: persistent 38-39°C fever of suspicious origin, and also they want me to gain weight because my BMI is 16).

They are giving me prednisone IV (intravenous), dosage is 40 mg in the morning and 20 mg in the evening.

The nurse came today's night to put me on omeprazole IV (proton pump inhibitor). The doctor had not told me before, so I don't know the reason.

So I asked the nurse and she didn't know either. She just told me that they put it on everyone who was receiving medication on my hospital floor.

I asked her if I could delay it in order to consult the doctor first.

Then... I'm impatient and curious, so I already checked pubmed, a IBD nursing guide, reddit, etc, but couldn't find relevant information. That's why I'm writing this thread.

Do you know if it is necessary to take omeprazole IV while on prednisone IV 60mg/d? (To clarify, I have no known ulcers or wounds in the small intestine).

When she said they put it on everyone on the hospital floor, it made me suspicious. Surely I prefer not to take it unless I really need it. No drama though.

In conclusion: Does anyone know about this? Any experience or opinion? I'll be reading you, thank you

 

[Cucurbita]

The doubt was resolved by the doctor, who visited me earlier today.

She said that she knows that a lot of doctors tend to prescribe omeprazol too often without a real justification.

But she said that in this case it is right and necessary to take it, because the dose of corticosteroids that I am receiving is high. So it's fine.

Extra information: omeprazol 40mg IV acts much quicker than taken orally; usually in 1 day it takes full effect. However, 20mg taken orally would require up to 5 days to achieve the maximum effect.

I'm leaving this information here in case it may be useful for someone in the future. Thank you.

 

[Rhoo]

Thanks for sharing! It may be useful to others.

 

[Lady Organic]

Thanks for the info Cucurbita. Im sorry about your hospital stay and flare and I hope you are feeling better now.
I read in another thread of yours that you were on a course of EEN last month. What happened so that you flared again? EEN did not work well?

 

[Cucurbita]

Thanks for the info Cucurbita. Im sorry about your hospital stay and flare and I hope you are feeling better now.
I read in another thread of yours that you were on a course of EEN last month. What happened so that you flared again? EEN did not work well?

Thank you very much for your good wishes. I'm better now.

You are right. EEN didn't work. After a month and a half, I had to be admitted to the hospital. A few days before, I also had a nephritic colic that worsened the situation: I lost further weight and weakened even more. My doctor wanted me to stay in the hospital due to, mainly, (i) a febrile symptom which they wanted to check if it was due to a complication or infection, and (ii) nutrition, because I was pretty underweight.

For those who use or will use EEN some day, know that if remission is to occur, it is usually apparent after 1 week of treatment. Do not wait longer if you can't see a substancial improvement after this timeframe.

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Regarding the nephritic colics, those are common in Crohn's disease. I will write about them because it could be of interest for other patients.

Normally the stones we (the Crohn's patients) develop are made of calcium oxalate. Among other things, it is related to the dysfunction of the ileum, which leads to malabsorb intestinal bile. Bilis should be absorbed in the final portion of the small intestine (and many of us have the ileum affected).

So bile acids nor fatty acids are absorbed. These have an affinity for calcium, so calcium cannot be absorbed well either. And it all goes to the colon, althought it shouldn't get here. Bile in the colon can cause irritation and negatively modify the microbiota.

In an healthy gut, calcium would get free so it forms a salt with oxalates. This salt of calcium and oxalate is expelled in the faeces. However, in our case, since calcium is linked to bile but oxalates are not, the salt cannot be form, so oxalates are absorbed very well in the colon. That is what causes the patient with ileum dysfunction to absorb high amounts of oxalate. If you combine this with a little dehydration (which causes the urine to become saturated and does not allow all the minerals and salts to dissolve well) and the higher-than-normal excretion of calcium than Crohn's patients usually have due (due to corticosteroids and the disease itself), the calcium and oxalates join together in the kidneys and form the insoluble salts we already speak of, which little by little form sand and then stones.