What are the management priorities for this patient who presents with sepsis, and at review has an enlarged liver and a glucose abnormality?
A 53-year-old man presented with a fever of 39C and profuse sweating. He had a mild sore throat, dysuria but no loin pain, and felt generally unwell.
Urinalysis showed pus cells, and culture revealed a multisensitive Escherichia coli. The patient had neutrophilia and some mild elevation of bilirubin (30 µmol/L) and gamma glutamyltransferase (GGT; 65 U/L). A random blood sugar level (BSL) was 7.8 mmol/L. Both his parents had become insulin dependent diabetic late in life.
The patient responded well to amoxycillin, but an ultrasound was organised via casualty due to concerns after 48 hours that he was still unwell and obstruction to his kidneys was considered a possibility. When seen in casualty he was afebrile and admitted to some recent excess of alcohol.