Chapter 1: Chapter 1

An elderly woman is admitted from a nursing home with confusion, fever and flank pain. She has a presumed urinary tract infection. On physical examination the temperature is 38.8 C (101.8 F), blood pressure is 66/50 mmHg, pulse rate is 125/min and respiratory rate is 24/min. Mucous membranes are dry, and there is costovertebral angle tenderness, poor skin turgor and no oedema. Haemoglobin is 10.5 g/dL, leukocyte count is 15,600/uL, and urinalysis shows 50-75 leukocytes/hpf and many bacteria/hpf. There is an increased anion gap metabolic acidosis. She is admitted to the intensive care unit and antibiotic therapy is started. Which of the following is the most appropriate next step in her resuscitation?