Multiple organ dysfunction syndrome (MODS) Quiz: Ace Your Exams

A 25-year-old man is brought to the emergency department by ambulance after he was thrown from his vehicle upon colliding with a tree. Temperature is 36.4 °C (97.5 °F), pulse is 135/min, blood pressure is 80/40 mmHg, respirations are 35/min and labored, and oxygen saturation is 89% on room air. He is awake but not responding to commands. Physical examination shows multiple lacerations with profuse bleeding. There is no tracheal deviation or jugular venous distension. Cardiac examination is significant for tachycardia with normal heart sounds. On pulmonary examination, there are decreased breath sounds on the left. There is abdominal distension and tenderness to palpation in the left upper quadrant. There is prolonged capillary refill and poor peripheral pulses. Focused assessment with sonography for trauma (FAST) shows splenic hemorrhage with blood in the abdomen. Blood work is obtained, and results are shown below. Chest x-ray shows small left-sided pneumothorax. ECG shows sinus tachycardia. The presence of which of the following features confirms the diagnosis of MODS?

Laboratory Value	Result	Reference
Leukocyte count	17,000/mm3	4,500-11,000/mm3
Hemoglobin	12.7 g/dL	13.5-17.5 g/dL
Platelets	125,000/mm3	150,000-450,000/mm3
Creatinine	2.3 mg/dL	0.6-1.2 mg/dL
Lactate	3.3 mmol/L	<2 mmol/L
AST	320 U/L	8-40 U/L
Alkaline phosphatase	170 U/L	20-70 U/L
Bilirubin	2.5 mg/dL	0.1-1.0 mg/dL