Confused and hypotensive

A 54-year-old woman has become increasingly unwell after approximately 36 hours of vomiting. She is now confused and hypotensive.

As you walk in

HR 118
BP 84/52
RR 22
SpO₂ 97% RA
T 38.1°C
GCS 13
BM 2.9 mmol/L
Sinus tachycardia

The diagnosis is not on the buzzer. Go to the bay and read the monitor before you decide.