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A 55-year-old man is evaluated in the intensive care unit for worsening respiratory distress and decreased urine output. He was admitted 3 days ago for severe acute necrotizing pancreatitis. Over the first 48 hours of his admission, he received 12 liters of lactated Ringer’s solution for aggressive volume resuscitation. Today, his respiratory status rapidly deteriorated, requiring endotracheal intubation and mechanical ventilation. The respiratory therapist notes that the patient's peak airway pressures are significantly elevated. The bedside nurse reports that his urine output has dropped to 80 mL over the last 6 hours. He is sedated and mechanically ventilated. His blood pressure is 85/55 mmHg with a heart rate of 120 bpm, and his temperature is 99.1°F (37.3ºC).
