Patient is intubated for airway protection. She is also resuscitated with 2 liters of IV crystalloid fluids.
Initial workup elicits the following:
Lab
- WBC 10.2 (normal differential), Hgb 11.4, Plt 190K
- Na+ 136, K+ 4.0, Cl– 110, HCO3– 24, BUN 52, Cr 2.6, Glucose 112
- AST: 27, ALT 25, Total Bilirubin 0.2, Albumin 3.2
- ABG: pH 7.48, PaCO2 31 mmHg, PaO2 84 mmHg
- ESR: 85, CRP: 22
- Urinalysis: Positive for large blood (with 3+ RBCs) and 2+ protein. Microscopy shows red blood cell casts
Imaging
- Chest X-Ray: Diffuse bilateral patchy infiltrates
What’s on your differential diagnosis?
What would you do next in the work-up for this patient?
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