Urosepsis: A simple infection turns toxic

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Excerpt

Mr. H, 70, presented to the ED with complaints of low back pain, painful urination, fever, and chills that began earlier in the day. He underwent a lithotripsy 1 week earlier and had a medical history significant for diabetes mellitus and liver transplant 5 years earlier. On initial presentation, Mr. H was awake, alert, and ambulatory; his vital signs were: temperature, 102° F (38.9° C); heart rate, 120 beats/minute; respiratory rate, 22 breaths/minute; and BP, 110/70 mm Hg.
Forty-five minutes later, Mr. H's vitals were: temperature, 103.2° F (39.6° C); heart rate, 132 beats/minute; respiratory rate, 28 breaths/minute; and BP, 80/50 mm Hg. His physical exam was significant for lethargy, dry mucous membranes, costovertebral angle tenderness, and mottling bilaterally up to his knees. His lab tests included a white blood cell count of 1,000/mm3 and lactic acid of 4.3 mmol/L. Mr. H was diagnosed with urosepsis and needed prompt interventions to avoid further hemodynamic compromise.
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