22nd May 2024

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

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever. His GP was concerned he may be septic. He has a history of Type 2 diabetes, COPD with multiple hospital admissions, benign prostatic hypertrophy, a long-term catheter and IHD. On review, he is lethargic. He opens his eyes when you speak to him but seems to drift off mid-sentence. He can follow basic commands. He responds to questions with single words, although he can’t tell you where he is or what day or month it is. He is on 2L oxygen via nasal cannula. His RR is 23, his saturations are 90%. His HR is 92, BP is 119/60. He is pyrexial at 38.9. His CRP is 200 mg/dL, Hb 98 g/L, 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 chest sounds clear. He looks euvolemic. There is minimal urine in his catheter. He has had 2000 ml of IV saline since arrival 2 hours ago, with only 20ml in urine output.

When you refer him to a level 2 unit, you are asked why you would like him there. What is the most appropriate response?

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