B.is a 35 year old admitted with decreasing level of consciousness and
respiratory distress. Overnight, he began to experience increasing distress,
necessitating intubation and ventilation. He develops hypotension, that
persists despite multiple fluid boluses that increases his CVP to 17.
HR is 128, minute volume requirements are 12.0 L/min, and his WBC is
22,000 (increased neutrophils). He is now on a norephinephrine infusion,
and blood cultures reveal gm positive cocci in the blood. Creatinine
is 101, with urine output 35 ml/hr. He is on broad spectrum antibiotics
and is started on hydrocortisone 100 mg q8h.
What do these clinical findings indicate?
What other medication should be considered?