A 50-year-old woman with stage 4 colon

A 50-year-old woman with stage 4 colon cancer had a surgery performed to remove the tumor as well as a colostomy. At first, the patient appears to be recovering very nicely. During the evening of the third postoperative day, however, the nurse on the night shift notes that the patient’s respiratory rate, which was 16-18 per min, has increased to 26 per min. The patient claims that she doesn’t feel overly sick. She is not short of breath or in pain, and her temperature is actually slightly subnormal (36.2ºC). By the next morning, she has slight fever (38.3ºC), but she continues to feel reasonably good. Her surgical wound shows no signs of infection. Later in the day, however, it becomes quite clear that the patient is in serious trouble. She is flushed, anxious, and restless. Her BP has dropped from 135/75 to 105/55, and her temperature is 39.2ºC. Her abdomen is tender to palpation and she also has an upset stomach and vomiting. The physicians speculate that the patient has developed post-operative peritonitis. The patient’s condition progressively worsens. Intravenous fluids are cut back, and a vasopressor is now required to maintain her blood pressure. Over the next 24 hrs, the patient continues to do poorly. Her urine output decreases almost to zero, and she requires mechanical ventilation to maintain oxygenation. She becomes increasingly edematous. In view of the clinical features and your preliminary diagnosis, what laboratory tests would you request to make a conclusive diagnosis? Assuming this patient has shock, how would you relate the lab reports and clinical findings in this patient to the pathophysiology of her condition? What type of shock is the patient likely suffering from?

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