22nd May 2025

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever.

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever. He is accompanied by his wife. They tell you that he has felt lethargic for 3-4 days and complained of some left shoulder pain and back pain. He has had rigors, but nil else in terms of positive symptomatology.  He weighs 83 kg, has a history of Type 2 diabetes, benign prostatic hypertrophy and IHD. On review, his GCS is 15. His RR is 23, his saturations are 94% on air. His HR is 132, and his BP is 88/60. He is pyrexial at 38.9. His CRP is 200 mg/dL, WCC 20 x 10⁹/L, platelets 200 x 10⁹/L, urea is 17 mmol/L and creatinine is 299 μmol/L from a baseline of 100. His lactate is 4. His chest sounds clear. He has had a 2500 ml IV crystalloid and has been catheterised. Urine output is 50ml in the last 3 hours. You move him to critical care where he is to commence noradrenaline to support his blood pressure.

What parameters would you use to titrate up/down his noradrenaline infusion?

Select the SINGLE most appropriate option from the list below. Select ONE option only.