A 64 year old lady presents with dysuria, suprapubic pain, and nausea and vomiting for 3 days. She also complains of right flank pain and fever since yesterday.

She has been on treatment for diabetes and hypertension for the last 8 years, with poor control, and is currently on insulin, losartan and amlodipine. She had temporarily stopped insulin for the last 3 days, given her reduced food intake.

She also underwent extracorporeal shock wave lithotripsy for recurrent renal calculi last year. A complete blood count is significant for a leukocyte count of 12,500/mm3, while a random plasma glucose level is 917 mg/dL.