Q. Did my father get peptic perforation due to high-dose steroid therapy?

Hi doctor,

I have some questions about COVID-19 prednisone therapy. My father just got out of the hospital. The doctor that my sister met online prescribes high doses of prednisone. I just wanted to ask your opinion about this prescription. My father recently suffered from a perforated peptic ulcer, and I am trying to figure out if his pulmonologist that he met online overprescribed prednisone that I believe led to the duodenal ulcer. I am looking for your opinion as a pulmonologist to ask if you think his prednisone prescription was lethally high or not. The medications are tablets like Allopurinol, Apixaban, Meclizine, Metoprolol, Symbicort, and Aleve. Please help.

Thank you.

Thank you doctor,

Initially, my father came down with gout. His general physician prescribed him 30 mg of Prednisone for five days. Later he was infected with COVID. When we consulted with an online doctor, he prescribed 60 mg of Prednisone for five days. After that, my father was brought to the hospital for four nights. There he received a course of Dexamethasone through an IV. When he left the hospital, they gave him a prescription for Dexamethasone, 6 mg for six days. At this time, my father was on the mend, with oxygen at home, and did not even have a cough. The online doctor did not think the hospital prescription was strong enough, so he wrote another prescription for 60 mg of Prednisone for five days, followed by 40 mg of Prednisone for five days and then 20 mg a day for five days. During the 40 mg per day dose week, he had abdominal pain. Two days later, he had emergency surgery because of duodenal ulcer perforation.

As you can see, it is almost a 30 day period of steroids, over 1000 mg in total. Was this second prescription safe to give an 80-year-old man on blood thinner? The online doctor did not prescribe Pepcid or any other antacid. The doctor also did not inform my father's physician regarding the increase in dosage of the prednisone prescriptions.

Please help.

Hi doctor,

Thank you for responding.

After the Covid hospital discharge, there was no cough or fever. I know the hospital took a chest X-ray. I will try to get it later today. I am not sure about the blood sugar level. My father died a month back. He never recovered from the perforation surgery. That is why this is so very important for me to find out what happened to him and if there was negligence or breach of duty care here. Please help.

Thank you doctor,

He never had a fever or a cough. If you give out a prescription for high-dose steroids, do you tell your patient not to use NSAIDs? Since my father was on the blood thinner, would that affect? How much dosage would you give to a patient on that Apixaban? Would you give an antacid to every patient that you would prescribe 60 mg a day of Prednisone, or would that depend on other factors? Does age change things? At what dosage of Prednisone would you give the antacid?

Please guide me.

Thank you doctor,

When you ask me if his blood sugar value was high, what number would be considered high for him?

Thank you doctor,

Do you ever prescribe Prednisone without seeing your patient in person?