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

A 74-year-old woman is brought to the emergency department by ambulance after being found unresponsive by her daughter. She has a history of hypertension, psoriatic arthritis, gastrointestinal reflux, and recurrent urinary tract infections. She takes lisinopril, methotrexate, naproxen, and omeprazole. She does not smoke or drink alcohol. Her temperature is 35.6 °C (96.08 °F), heart rate is 120/min, blood pressure is 80/40 mmHg, and respirations are 25/min. Pulse oximetry is 82% on room air. She is mumbling and not responding to commands. Cardiopulmonary examination is normal without JVD. Extremities reveal slow capillary refill. Blood work is obtained, and results are shown below. ECG shows sinus tachycardia. Chest x-ray is normal. Intravenous fluid resuscitation and empiric broad-spectrum antibiotics are administered. In addition to hemodynamic monitoring, which of the following is the most appropriate way to monitor this patient’s condition?

Laboratory Value	Result
Leukocyte count	17,000/mm3
Hemoglobin	36.7 g/dL
Creatinine	3.2 mg/dL
AST	320 U/L
Alkaline phosphatase	170 U/L
Bilirubin	2.5 mg/dL
CPK	25 U/L
Lactate	4.2 mmol/L (Reference: Less than 2 mmol/L)