History, more important than physical exam

So I ran this lady with AMS. And by altered mental status I mean, she was totally unresponsive. But her vitals were all perfect, she was defending her airway beautifully, her lungs were clear, her EKG was better than mine and her blood glucose was normal. Baffling.

So then I decide to read her paperwork, since of course, the report I got from the SNF consisted of helpful comments like "I don't work with her usually" and "I'm calling her daughter, so I can't talk to you right now."

In there I discover that she's had multiple admissions for sepsis where she presented with AMS. Aha! Lightbulb! I check her lactate. It's 6.5. I start her IV and hang some fluid. And then I go back to reading.

And then, there is was. In the nurses notes: "Recently, patient has been playing in her feces more. She has been seen rubbing them in her vagina and licking her fingers. Also, this morning Ms. CNA found a ball of stool in her coffee, which she was drinking."

...

Guys, I think I found the problem.