A woman in her 50s with chronic fatigue syndrome, sepsis and hyponatraemia.

A woman in her 50s was found at home by her husband, who was unable to communicate with her. She had been coughing and feeling lethargic and unwell for the previous few days. The woman used no drugs on a regular basis. When the ambulance crew arrived, she was disorientated, with a Glasgow Coma Scale (GCS) score of 13. Her temperature was 40.5 °C. She was given 500 ml Ringer’s acetate intravenously on her way to Acute Admissions. In Acute Admissions, she could move her extremities, was free of pain and her neck was not stiff. Her GCS score was unchanged. Her skin was dry, warm and without petechiae. Her blood pressure was low (88/61 mm Hg – 105/51 mm Hg – 91/60 mm Hg – despite infusion of 2 000 ml Ringer’s acetate. Her pulse was regular, between 113 and 126 beats/minute, her temperature was 39.7 °C, SpO2 was 97 % with 3 l O2 and her respiratory rate 20 – 25 per minute. On auscultation, reduced respiratory sound over the right lung, most pronounced basally. Blood tests on admission are shown in Table 1. Blood gases were taken arterially in room air. The urine strip test showed traces of albumin and blood, otherwise normal findings. The rapid urine antigen test for pneumococcus was negative. Chest x-ray showed an opacity in hilar position on the right side, consistent with pneumonia infiltrate.