Jon-Emile S. Kenny [@heart_lung] A 23 year old woman is admitted with severe abdominal pain following 5 days of profound non-bloody diarrhea and 72 hours of recalcitrant non-bloody emesis. She has lost 7 pounds in this time frame and has been unable to maintain oral hydration. Her eyes are sunken and her vital signs are notable for a heart rate of 144, blood pressure 70/55, her respiratory rate is 32 and she is afebrile. A CT of her abdomen reveals significant colitis and ileus and a point of care venous blood gas demonstrates the following: pH 7.19, PvCO2 91 mmHg and venous oxygen saturation of 91%. Her lactate is 8.0 mmol/L; a sepsis alert is called