Symptoms and signs Laboratory Treatment a Fever Malaise Prednisone 1–2 mg/kg/day Infection CBC, urinalysis, ESR, anti-DNA antibodies CH50 , C3 Cultures (blood, urine, CSF, stool and appropriate secretions) Chest radiograph Gallium scan Same as above Fever, headache, seizure, cough, sputum, skin lesions, arthritis, disease flare, weight loss Dehydration, fever, Urinalysis, urine weight gain, culture, 24-hr urine hypertension, protein decreased urine Serum creatinine output Creatinine clearance Anti-DNA CH50 , C3, C4 CBC, ESR, platelets Electrolytes, BUN Fatigue, malaise, CBC, Coombs’, pallor, dyspnea, reticulocyte count, edema haptoglobin Peripheral smear Total bilirubin Renal disease Hemolytic anemia Central Seizures, coma, EEG, MRI, CT scan Intravenous antibiotics (broad spectrum) Reevaluate prednisone dose Prednisone “pulse therapy” (as needed) Cytotoxic agents (azathioprine PO or cyclophosphamide IV) Plasmapheresis Immunosuppressive agents Prednisone mg/kg/day Transfusion, if acute emergency (may need consultation with transfusion specialist to avoid acute hemolysis of transfused blood products) ICU admission