Shock and multisystem hypoperfusion
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A 68-year-old woman has had profuse diarrhea for 2 days. Her pulse is 124/min and blood pressure is 116/72 mm Hg. Her extremities are cool, capillary refill takes 5 seconds, and urine output has fallen to 0.2 mL/kg/hour. Oxygen saturation is 98% on room air, hemoglobin is 14.1 g/dL, and serum lactate is 4.1 mmol/L (reference 0.5–2.0).