A 58-year-old adult with type 2 diabetes and recurrent kidney stones arrives with 2 days of fever, right flank pain, dysuria, and vomiting. The spouse states the client worked a full day 2 days ago and managed all of their own medications. Creatinine last year was 0.9 mg/dL. Current findings: temperature 39.4 C (102.9 F); right flank pain rated 7/10; burning and frequency with urination; vomited twice since midnight. HR 124/min, RR 28/min, BP 82/48 mm Hg (MAP 59), SpO2 94% on room air. Lungs clear in all fields. The skin is warm; knees mottled, capillary refill 4 seconds. 15 mL of urine in the past 2 hours. Abdomen soft with active bowel sounds. The client cannot name the month or the hospital and answers slowly. Numbness of both feet since 2019. Capillary glucose 186 mg/dL. Lactate, cultures, and imaging are pending.
一位 58 歲患有2型糖尿病和復發性腎結石的成年個案，因發燒、右腰痛、排尿困難和嘔吐 2 天而入院。配偶表示個案 2 天前還正常工作一整天，並自行管理所有藥物。去年肌酸酐為 0.9 毫克/分升。目前發現：體溫 39.4 C (102.9 F)；右腰痛評分 7/10；排尿時有灼熱感和頻尿；午夜以來嘔吐兩次。心率 124 次/分，呼吸頻率 28 次/分，血壓 82/48 mmHg (MAP 59)，室內空氣下血氧飽和度 94%。所有肺野清澈。皮膚溫暖；膝蓋花斑皮膚，微血管再充填時間 4 秒。過去 2 小時尿量 15 毫升。腹部柔軟，有活躍的腸蠕動音。個案無法說出月份或醫院，且回答緩慢。自 2019 年以來雙腳麻木。微血管血糖 186 毫克/分升。乳酸、培養和影像學檢查結果待定。