A 72-year-old woman with a history of lung cancer and hypertension presents to the emergency department with diarrhea, which has persisted for 1 to 2 weeks. The patient is on a stable chemotherapy regimen that has not caused this degree of diarrhea previously. She denies any vomiting, bleeding, or fever. She has mild intermittent abdominal cramping but no real pain. She mentions that her right leg has been cramping intermittently for the last 4 days. She denies back pain, urinary symptoms, or other complaints.

Vital Signs and Physical Examination

The patient’s vital signs are normal except for a pulse rate of 97 beats per minute, white blood cell count 22,000/uL, and blood urea nitrogen (BUN)/creatinine 101/4.7 mg/dL (Systemic inflammatory response syndrome [SIRS] criteria >90 beats/min). The patient’s blood pressure is slightly low, her abdomen is normal, and her legs are mottled and darkened (Figure). Electrocardiogram is normal.

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