Diagnose It Answer — April 5, 2026

78-year-old female brought in from a long-term care facility with altered mental status and decreased responsiveness over the past 12 hours. Staff reports she was 'not herself' at breakfast, then became increasingly confused and difficult to rouse by noon. She has a known urinary catheter.

History of type 2 diabetes, chronic kidney disease stage 3, and recurrent urinary tract infections. Resides in a skilled nursing facility. Current medications include metformin, lisinopril, and furosemide. No reported fever at the facility, but nursing staff noted urine was cloudy and foul-smelling this morning.

BP 88/54 mmHg, HR 118 bpm, RR 26 breaths/min, Temp 38.9°C (101.9°F), SpO2 92% on room air. GCS 11 (E3 V3 M5). Patient is tachycardic, hypotensive, febrile, and tachypneic — meeting criteria for organ dysfunction in the setting of suspected infection.

SOFA score calculated at 6, consistent with organ dysfunction. Patient is lethargic and responds only to voice. Skin is warm and flushed with capillary refill of 3 seconds. Abdomen soft, mildly tender suprapubically. Foley catheter draining turbid, dark amber urine. Two large-bore IVs established; 30 mL/kg IV crystalloid bolus initiated per Sepsis-3 protocol.

WBC 21,400/µL with 18% bands. Lactate 4.2 mmol/L (critically elevated). Procalcitonin 38 ng/mL. Creatinine 2.8 mg/dL (baseline 1.4). Blood cultures x2 drawn before antibiotics. Urinalysis: positive nitrites, >50 WBCs/hpf, positive leukocyte esterase. Chest X-ray clear. Broad-spectrum antibiotics ordered.