Question:
According to the NASCIS (National Acute Spinal Cord Injury Study) protocol, what is the recommended dose of methylprednisolone for acute spinal cord injury?
According to the NASCIS (National Acute Spinal Cord Injury Study) protocol, what is the recommended dose of methylprednisolone for acute spinal cord injury?
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NASCIS dosing regimen to memorize: Bolus $30 \text{ mg/kg}$ over 15 min $\rightarrow$ Wait 45 min $\rightarrow$ Infusion $5.4 \text{ mg/kg/hr}$. It must be initiated within 8 hours of the acute injury to have any theoretical benefit.
Updated On: Sep 3, 2026
- Not indicated
- 30 mg/kg IV bolus over 15 minutes
- 2g bolus over 15mins
- 270mg/hr over 24hrs
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The Correct Option is B
Solution and Explanation
Concept:
The question asks for the specific initial intravenous dosing regimen of methylprednisolone for acute spinal cord injury as evaluated and established in the historical NASCIS (National Acute Spinal Cord Injury Study) clinical trials.
This is a direct pharmacological recall question regarding a highly specific trauma protocol.
Explanation:
• The NASCIS trials were major studies that investigated whether administering high-dose corticosteroids could reduce secondary inflammatory damage, limit lipid peroxidation, and improve long-term neurological outcomes after acute spinal cord injury if given very shortly after the trauma.
• The NASCIS II protocol specifically defined the exact dosing regimen for methylprednisolone that showed some statistical benefit.
• The protocol mandates an initial, massive intravenous loading dose of $30 \text{ mg/kg$ administered as a bolus over 15 minutes}.
• This initial loading dose is followed by a strict 45-minute pause where no drug is administered.
• After the 45-minute pause, a continuous maintenance infusion of $5.4 \text{ mg/kg/hour}$ is started. This infusion is maintained for 23 hours if the initial therapy was started within 3 hours of the injury, or for 48 hours if therapy was started between 3 and 8 hours of the injury.
• It is very important to note clinically that while this protocol is frequently tested in exams, its actual use in modern surgical practice is highly controversial. Many neurosurgical guidelines now actively advise against the routine use of steroids due to only marginal neurological benefits combined with severe, proven risks of systemic complications (like sepsis, pneumonia, and GI bleeding).
• However, for standardized exams asking specifically about the historical NASCIS protocol, the exact dosing must be known.
Final Answer:
The recommended NASCIS initial loading dose is a $30 \text{ mg/kg}$ IV bolus administered over 15 minutes.
The question asks for the specific initial intravenous dosing regimen of methylprednisolone for acute spinal cord injury as evaluated and established in the historical NASCIS (National Acute Spinal Cord Injury Study) clinical trials.
This is a direct pharmacological recall question regarding a highly specific trauma protocol.
Explanation:
• The NASCIS trials were major studies that investigated whether administering high-dose corticosteroids could reduce secondary inflammatory damage, limit lipid peroxidation, and improve long-term neurological outcomes after acute spinal cord injury if given very shortly after the trauma.
• The NASCIS II protocol specifically defined the exact dosing regimen for methylprednisolone that showed some statistical benefit.
• The protocol mandates an initial, massive intravenous loading dose of $30 \text{ mg/kg$ administered as a bolus over 15 minutes}.
• This initial loading dose is followed by a strict 45-minute pause where no drug is administered.
• After the 45-minute pause, a continuous maintenance infusion of $5.4 \text{ mg/kg/hour}$ is started. This infusion is maintained for 23 hours if the initial therapy was started within 3 hours of the injury, or for 48 hours if therapy was started between 3 and 8 hours of the injury.
• It is very important to note clinically that while this protocol is frequently tested in exams, its actual use in modern surgical practice is highly controversial. Many neurosurgical guidelines now actively advise against the routine use of steroids due to only marginal neurological benefits combined with severe, proven risks of systemic complications (like sepsis, pneumonia, and GI bleeding).
• However, for standardized exams asking specifically about the historical NASCIS protocol, the exact dosing must be known.
Final Answer:
The recommended NASCIS initial loading dose is a $30 \text{ mg/kg}$ IV bolus administered over 15 minutes.
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