67 year old female presents to ED with generalized weakness and altered mental

status. Patient also reports fever and chills. Husband reports patient was well
until previous night of presentation to ED in which she reported pain with
urination and urination frequency.

ROS: no headaches, no visual or audio disturbances, no joint pain

PMHx: Has diabetes, hypertension, history of UTI's, and breast cancer s/p
lumpectomy few years ago
Meds: Metformin, Lisinopril, Empagliflozin, Glargine, Letrozole
Allergies: NKDA
FHx: N/A
SHx: N/A

PE:
-General: older aged obese female, ill appearing. Mental status waxing and waning,
Oriented to self but not time or place.
-Vitals: Temp-101.8 HR-112 RR-27, BP-98/62, BMI-34
-Skin: Warm, flushed skin.
-HEENT: no inflammation, moist and pink mucosa, sclera normal, no LAD
-Lungs: Shallow rapid breathing. CXR unremarkable
-Cardio: Tachycardia
-ABD: Obese. Suprapubic tenderness noted, no guarding or rebound tenderness. No CVA
tenderness. No liver or spleen enlargement noted
-PVS: No clubbing or cyanosis. Trace pitting edema. No calf tenderness or redness.

Assessment:
DDX1: Septic shock from UTI----> history of UTI's, fever, chills, hypotension, warm
& flushed skin, nitrates found in urinalysis
DDX2: DIC----> infection, tachycardia, hyptension, altered mental status
DDX3: DKA----> Diabetes history, altered mental status, hyperventilation

Plan:
Patient meets SIRS criteria for septic shock. Admit to ICU. Secure airway,
supplemental oxygen, fluids, vasopressors, antibiotics (quinilones), maintain
glycemic control with insulin and counseling, heparin to prevent DVT in bedridden
patient. Council on obesity. Obtain family and social history.