The patient receives an intravenous fluid bolus of normal (0.9%) saline. Unfortunately, she remains hypotensive and is transferred to the intensive care unit. Her chest x-ray reveals a multifocal pneumonia. On day two of her hospitalization, she further decompensates and requires intubation. She receives more intravascular resuscitation but norepinephrine is required for persistent hypotension. Her urine output is now less than 10 mL per hour.
The patient has repeat labs sent.
Urinalysis/microscopy, urine electrolytes
Has your differential changed? What is your leading diagnosis now (choose 1)?