A 60-year-old man is brought to the ED for a 12-hour history of fever and abdominal pain. He has a history of ischemic heart disease for which he takes daily aspirin. He drinks home-brewed beer on weekends. He works part-time running a car washing business. Vitals are: temperature 101 F, HR 100, BP 80/60. Abdominal examination shows right lower quadrant tenderness with guarding and rebound. Laboratory studies show:
Leukocytes 18,000/μL with a shift to the left
Sodium 140 mEq/L
Chloride 105 mEq/L
Bicarbonate 17 mEq/L
pCO2 32 mmHg
Which of the following is the most likely explanation for these findings?
