A 68-year-old man with bilateral percutaneous nephrostomy tubes is brought to the emergency department by his wife because of confusion. She adds that he complained of right flank pain yesterday. He has prostate cancer and receives leuprolide injections every 3 months. He is oriented to person but not to place or time. Temperature is 38.9 C (102 F), blood pressure is 80/50 mm Hg, pulse is 130/min, and respirations are 20/min. The right nephrostomy bag contains a small amount of cloudy urine; the left nephrostomy bag contains clear urine. Laboratory results are as follows: Which of the following is most likely decreased in this patient?

Question

A 68-year-old man with bilateral percutaneous nephrostomy tubes is brought to the emergency department by his wife because of confusion. She adds that he complained of right flank pain yesterday. He has prostate cancer and receives leuprolide injections every 3 months. He is oriented to person but not to place or time. Temperature is 38.9 C (102 F), blood pressure is 80/50 mm Hg, pulse is 130/min, and respirations are 20/min.  The right nephrostomy bag contains a small amount of cloudy urine; the left nephrostomy bag contains clear urine. Laboratory results are as follows:  Which of the following is most likely decreased in this patient?

Quizplus · Accepted Answer

Eductional Objective: Septic shock is a dysfunctional host response to an infectious pathogen resulting from massive upregulation of vasodilators.  A vasopressin deficit contributes to unbalanced vasodilation and refractory hypotension.

A 68-Year-Old Man with Bilateral Percutaneous Nephrostomy Tubes Is Brought