December 8, 1975

Status Asthmaticus

JAMA. 1975;234(10):1016. doi:10.1001/jama.1975.03260230016004

To the Editor.—  The article, "Status Asthmaticus" (231:1277, 1975), by Senior et al was very well done. Nevertheless, we would like to make some additional points.The combination of vigorous hydration and large doses of hydrocortisone in a patient with underlying cardiopulmonary disease can cause heart failure as a result of sodium and fluid retention. Daily weights and strict attention to intake and output may be helpful in early detection of this problem. Methylprednisolone sodium succinate (Solu-Medrol), even though more expensive with its lesser mineralocorticoid effect, could be substituted for the hydrocortisone if fluid retention is a problem.Because it is the rare laboratory that can immediately obtain a serum theophylline level, physicians and nurses should be keenly aware of the early clinical manifestations of theophylline toxicity, eg, gastrointestinal distress, cutaneous vasodilation, and stimulation of the central nervous system. In addition, it is extremely important for the treating physician to