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Annals for Hospitalists Inpatient Notes - Understanding the 2021 Surviving Sepsis Campaign Guidelines Recommendations on Fluid Resuscitation in Sepsis

A 65-year-old man presents to the emergency department with fever, chills, pleuritic chest pain, and pro-ductive cough. He has stage 3 chronic kidney disease and heart failure with a left ventricular ejection fraction of 45% to 50%. He is confused, with crackles in the right lung base, dry mucus membranes, and warm extremities. Vital signs are blood pressure of 86/48 mm Hg (mean ar-terial pressure of 61 mm Hg), heart rate of 120 beats/min, respiratory rate of 28 breaths/min, and Sp O 2 of 93% on 2 L of oxygen. His chest radiograph shows a dense right lower lobe in ﬁ ltrate. His laboratory results are notable for a lactate level of 4.2 mmol/L and a creatinine level of 247.52 μ mol/L (2.8 mg/dL) (baseline 141.44 μ mol/L [1.6 mg/dL]) .