An HIV positive male, admitted to the ICU with septic shock secondary to lobar pneumonia, is being mechanically ventilated. After 2 days of IV ceftriaxone, trimethoprim-sulfamethoxazole, and erythromycin, his fever has resolved. Blood cultures are positive for S. pneumoniae. SpO2 is 92% on room air and BP is 80/40 mm Hg, despite adequate fluids and 2 mcg/kg/min of norepinephrine. Fuher examination reveals warm skin and full peripheral pulses. What is the next best step in management?

* Extremities are warm to touch and full peripheral pulses. (WARM SHOCK) Option C- No survival advantage for the patients Option D- Already the patient is afebrile, so no point in checking the sensitivity of bacteria to antibiotics. Patient has a condition k/a DISTRIBUTIVE SHOCK Hydrocoisone is given in this case. * Hydrocoisone is not given in Septic shock Always consider adrenal insufficiency in the differential diagnosis of distributive shock, paicularly when no other cause is present or an original cause appears to be under effective treatment, as in this patient. Refractory hypotension suggests adrenal insufficiency, especially with concomitant HIV infection in the face of effective treatment of sepsis. Searching for a second source of infection would be appropriate in an HIV-infected patient.