A 52 year-old-male presented to the ER with decreased oral intake for two weeks, altered mental status and syncope. He had a history of peripheral vascular disease, hepatitis C virus infection, and was recently hospitalized for an infected sacral decubitus ulcer. Clinical examination On examination in the ER, the patient was found to be hypotensive and tachycardic, with systolic BP of 60 mmHg and a heart rate of 60 bpm, respectively.
After acute management, the patient was transferred to the ICU. Diagnostic work-up post ICU admission Vitals: Temperature 95.2°F; Pulse: 82 bpm; Respiration rate: 18 bpm; Blood pressure: 95/63 mmHg Sodium: 133 mEq/L Potassium: 4.8 mEq/L Chloride: 92 mEq/L Bicarbonate: 24 mEq/L Blood urea nitrogen (BUN): 57 mg/dL Creatinine: 2.1 mg/dL Glucose: 168 mg/dL Arterial blood gas: pH: 7.34 pCO2: 39 mmHg pO2: 179 mmHg Anion gap: 17 mEq/L Lactic acid: 7.6 mg/dL…
