Clinical Case Scenario
A 48-year-old woman with type 2 diabetes mellitus and hypertension presented with a 2-day history of fever and dysuria. She had been taking oral antibiotics prescribed at a local clinic. Despite this, the fever persisted, and she developed multiple episodes of vomiting with poor oral intake. She also complained of dull, diffuse abdominal pain.
Her regular medications include amlodipine, telmisartan-hydrochlorothiazide, metformin, glimepiride, and dapagliflozin.
On examination:
- Conscious, oriented
- BP 90/45 mmHg
- HR 120/min
- RR 22/min
- SpO₂ 97% on room air
- Per-abdomen examination: soft, non-distended, and non-tender.
ABG:
- pH 7.42
- PaCO₂ 34 mmHg
- HCO₃⁻ 23 mmol/L
Laboratory values:
- Na 124 mmol/L
- K 5.8 mmol/L
- Cl 83 mmol/L
- Glucose 180 mg/dL
- Lactate 0.8 mmol/L
- Albumin 3.0 g/dL
- Serum osmolality: 270 mOsm/kg H₂O
- Urine spot sodium: 62 mmol/L
- Urine osmolality: 630 mOsm/kg H₂O
- Blood urea: 77 mg/dL
- Serum creatinine: 0.8 mg/dL
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