›Class I evidence against routine steroid use in GBS
›Supportive care in GBS
›Serial FVC and NIF every 4 to 6 hours
›DVT prophylaxis with LMWH or UFH
›Pain management
›Gabapentin 300 to 600 mg three times daily for neuropathic pain
›Opioids for refractory pain with respiratory monitoring
Myasthenic crisis treatment
›Crisis management
›ICU admission mandatory
›Avoid exacerbating medications
›No aminoglycosides, magnesium, beta-blockers, or fluoroquinolones
›Pyridostigmine hold in cholinergic crisis
›Differentiate with clinical assessment not edrophonium
›IVIg for crisis
›2 g/kg over 2 to 5 days
›Onset of effect 3 to 5 days
›Plasmapheresis for crisis
›5 to 6 sessions over 1 to 2 weeks
›Faster onset than IVIg in some patients
›Ongoing myasthenia management
›Pyridostigmine
›30 to 60 mg PO every 3 to 6 hours as symptomatic therapy
›Maximum 120 mg per dose
›Prednisone for long-term immunosuppression
›1 mg/kg/day PO up to 60 mg daily
›Taper over months guided by clinical response
Inflammatory myopathy treatment
›Initial immunosuppression
›Prednisone
›1 mg/kg/day PO up to 60 to 80 mg daily
›Maintain until CK normalizes and strength improves
›Slow taper over 6 to 12 months
›Methotrexate as steroid-sparing agent
›15 to 25 mg weekly PO or SC
›Folic acid 1 mg daily supplementation required
›Azathioprine as steroid-sparing alternative
›2 to 3 mg/kg/day PO
›Monitor CBC and LFTs monthly
›Rheumatology guidance required for initiation
›Class IIa recommendation for steroid-sparing agents
Metabolic and endocrine treatment
›Hypothyroidism
›Levothyroxine
›1.6 mcg/kg/day PO for most adults
›IV formulation if myxedema coma suspected
›300 to 500 mcg IV load then 50 to 100 mcg IV daily for myxedema coma
›Adrenal insufficiency
›Hydrocortisone
›100 mg IV bolus for adrenal crisis
›Followed by 50 mg IV every 6 hours or continuous infusion 200 mg over 24 hours
›Oral replacement after stabilization 15 to 25 mg daily in divided doses
›Anemia
›Packed red blood cell transfusion
›Threshold Hgb < 70 g/L in stable patients
›Threshold Hgb < 80 g/L in cardiac disease or symptomatic anemia
›Iron supplementation
›Iron sucrose 200 mg IV for iron deficiency when oral not tolerated
›Oral ferrous sulfate 325 mg PO three times daily when tolerated
›Initial resuscitation
›IV fluid bolus
›30 mL/kg crystalloid within first 3 hours
›Reassess fluid responsiveness at each step
›Broad-spectrum antibiotics within 1 hour of recognition
›Piperacillin-tazobactam 4.5 g IV every 6 hours for undifferentiated sepsis
›Vancomycin 25 to 30 mg/kg IV loading dose if MRSA concern
›Vasopressors for refractory hypotension
›Norepinephrine 0.01 to 0.5 mcg/kg/minute as first-line vasopressor
›Target MAP >= 65 mmHg