Which patient should not begin hydrocortisone therapy?

Hydrocortisone therapy, a type of corticosteroid treatment, is often used in various clinical situations, including managing sepsis due to its anti-inflammatory and immunosuppressive properties. Patients with sepsis may benefit from hydrocortisone, especially in cases of septic shock where corticosteroids can help improve blood pressure and function of various organs by mitigating the inflammatory response.

On the other hand, patients with diabetes, hypertension, and hyperlipidemia can still potentially use hydrocortisone, but there's a need for careful monitoring and management of their underlying conditions while on treatment. These conditions can complicate the use of hydrocortisone due to its effects on glucose metabolism, blood pressure, and lipid profiles. However, they do not outright contraindicate the therapy as seen in the case of sepsis.

Sepsis is a severe, systemic infection that can lead to multiple organ dysfunction. While hydrocortisone can be beneficial, it is critical to assess the patient's overall clinical condition and the risk/benefit ratio before initiating such therapy in an acute setting. Therefore, the decision to avoid hydrocortisone in a patient with sepsis reflects a careful consideration of the potential risks involved versus the benefits when managing such critical conditions.