Ridgeview Memorial Hospital

Inpatient Progress Note — Hospital Medicine

Patient: J. Delgado MRN: 88213-A4 DOB: --/--/1967 (58 yo M) Admit date: Day 1 POS: 21 - Inpatient Attending: R. Castellano, MD History of present illness:

58-year-old male with no significant past medical history presented to the emergency department with 2 days of dysuria and fever. Alert and fully oriented on arrival.

Vitals and initial labs:

Temp 38.9C, HR 108, BP 88/54 at 0620 (MAP 65), RR 20, SpO2 97% on room air. WBC 15.4, lactate 1.8 mmol/L at 0615. Urinalysis showed greater than 100 WBC/hpf with positive

nitrites and leukocyte esterase. Blood cultures x2 drawn on admission.

Hospital course:

1 L crystalloid bolus started 0630 with transient improvement (BP 102/64 at 0710), but

blood pressure fell again to 84/50 (MAP 61) at 0745, meeting rapid response criteria.

Despite a total of 30 mL/kg crystalloid, MAP remained below 65 mmHg; norepinephrine was started at 0900 and titrated to maintain MAP greater than 65 mmHg, continuing for 20

hours until weaned off at 0500 hospital day 2. Lactate drawn at 0930, after adequate

fluid resuscitation and shortly after pressor initiation, was 3.6 mmol/L; repeat lactate

at 2400 was 2.1 mmol/L, trending to 1.1 mmol/L by 0500 day 2. Blood cultures resulted positive for Escherichia coli, matching urine culture (E. coli greater than 100,000

CFU/mL). Empiric ceftriaxone narrowed to ciprofloxacin per sensitivities.

Assessment and plan:

Severe sepsis with septic shock secondary to E. coli urosepsis, requiring 20 hours of vasopressor support to maintain MAP goal, now resolved and off pressors. Discharged

hospital day 5 on oral antibiotics with primary care follow-up scheduled.