A patient with systemic lupus erythematosus is on chronic prednisolone 15 mg/day. She develops fever, hypotension, and confusion during a disease flare. Which is the most appropriate immediate management?
- A Administer intravenous hydrocortisone 100 mg bolus followed by continuous infusion ✓
- B Double the oral prednisolone dose
- C Start oral dexamethasone 4 mg daily
- D Add pulsed methylprednisolone 500 mg IV without changing the baseline steroid
Correct answer: A. Administer intravenous hydrocortisone 100 mg bolus followed by continuous infusion
Explanation
B patient on chronic steroids who presents with acute illness and hemodynamic compromise requires immediate parenteral stress-dose steroids. Intravenous hydrocortisone 100 mg bolus followed by 50-100 mg every 6 to 8 hours is standard, as it provides both glucocorticoid and mineralocorticoid activity. Oral absorption may be unreliable in shock, and simply doubling the oral dose is inadequate.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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