Mps dose protocol
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methylprednisolone MPS dose protocol spinal cord injury asthma 2024
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Here is a comprehensive overview of the Methylprednisolone (MPS) Dose Protocol across major indications:
Methylprednisolone (MPS) Dose Protocols
1. Acute Spinal Cord Injury (SCI) - NASCIS II Protocol
This is the most referenced "MPS protocol" in emergency medicine.
| Parameter | Detail |
|---|---|
| Indication | Blunt trauma with neurologic deficit referable to the spinal cord |
| Time window | Must start within 8 hours of injury |
| Loading dose | 30 mg/kg IV bolus over 15 minutes |
| Pause | 45-minute pause after bolus |
| Maintenance | 5.4 mg/kg/hr IV continuous infusion for 23 hours |
| Duration | 24 hours total (if started within 3 hrs of injury) |
Important caveat: Current guidelines from the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) state that high-dose methylprednisolone should NOT be routinely used in acute SCI. The NASCIS trials were based on post-hoc subgroup analyses and were criticized for bias. High-dose protocols are associated with severe sepsis, pneumonia, wound infections, GI bleeding, and DVT/PE. - Tintinalli's Emergency Medicine, p. 1755
2. Asthma Exacerbations
| Population | Route | Dose | Frequency | Duration |
|---|---|---|---|---|
| Child ≤12 yr | IV/IM/PO | 1-2 mg/kg/day (max 60 mg/day) | Q12 hr | Until PEF ≥70% predicted |
| Child >12 yr and adult | IV/IM/PO | 40-80 mg/day | Q12-24 hr | 3-10 days |
| Child ≤5 yr (alternative) | IV/IM/PO | 1 mg/kg/dose Q6 hr × 24 hr | Q6 hr | Then oral to complete 3-5 days |
| Child ≤4 yr (IM, if vomiting) | IM | 7.5 mg/kg (max 240 mg) | Single dose | - |
| Child >4 yr/adult (IM) | IM | 240 mg | Single dose | - |
(Based on NHLBI 2007 guidelines, Harriet Lane Handbook 23rd ed.)
3. Pulse Therapy (Severe Inflammatory/Autoimmune Conditions)
Used in lupus nephritis, vasculitis, GPA/MPA, severe rheumatic disease, and severe dermatologic conditions.
| Condition | Dose | Duration |
|---|---|---|
| General pulse (adult) | 0.5-1 g IV over 30-60 min | 3 days |
| Pediatric pulse | 15-30 mg/kg/dose IV (max 1000 mg/dose) | 3 days |
| Rheumatologic (induction) | 30 mg/kg/dose (max 1000 mg) | 3 days |
| Lupus nephritis (KDIGO 2024) | 0.25-0.5 g/day IV | Up to 3 days |
| GPA/MPA (RPGN) | 7 mg/kg IV (max 500-1000 mg) | 3 days |
4. Anti-inflammatory / Immunosuppressive (General)
- PO/IM/IV: 0.5-1.7 mg/kg/24 hr divided Q6-12 hr
5. Anaphylaxis (Adjunct)
- 1-2 mg/kg IV - adjunct only; epinephrine remains the primary treatment
6. Acute Rejection (Transplant)
- IV methylprednisolone 1 g for 3 consecutive days, followed by oral prednisone 1 mg/kg/day (often combined with rituximab or cyclophosphamide)
7. Severe Ulcerative Colitis
- Methylprednisolone 60 mg IV daily for remission induction (ACG guidelines)
Key Practical Notes
- Use the succinate salt (methylprednisolone sodium succinate) for IV/IM administration; the acetate form is for IM depot use only
- Available as: 40 mg, 125 mg, 500 mg, 1000 mg, 2000 mg vials for injection
- No dose adjustment needed for hepatic or renal impairment in most protocols
- For neonates: avoid formulations containing benzyl alcohol as solvent
Context clarification: "MPS" most commonly refers to methylprednisolone sodium succinate (brand: Solu-Medrol). If you meant MPS disease (Mucopolysaccharidosis) or another abbreviation, let me know and I'll redirect accordingly.
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