Case 78
A n 81-year-old man with diabetes but no
known cardiac dis eas e and plans for
below-the-knee amputation of his right leg for
s evere os teomyelitis and unhealed s kin ulcers
develops profound hypotens ion and altered mental
s tatus requiring vas opres s or therapy. He is
intubated and admitted to the intens ive care unit.
Initial laboratory as s es s ment reveals acute renal
ins ufficiency, hyperkalemia, lactic acidos is , and
a blood pH of 7.10. Blood cultures grow methicillin-
What is the diagnosis?
res is tant Staphylococcus aureus . Des pite antibiotic
therapy, his clinical s ituation wors ens . Overnight,
he acutely los es blood pres s ure and the following
ECG is captured on telemetry.
337