 This is a 53-year-old Hispanic man with diabetes, morbid obesity, hepatitis C, cirrhosis, history of alcohol and cocaine abuse, who presented in the emergency room on 01/07/09 for ground-level fall secondary to weak knees.  He complained of bilateral knee pain, but also had other symptoms including hematuria and epigastric pain for at least a month.  He ran out of prescription medications 1 month ago.  In the ER he was initially afebrile, but then spiked up to 101.3 with heart rate of 130, respiratory rate of 24.  White blood cell count was slightly low at 4 and platelet count was only 22,000.  Abdominal ultrasound showed mild-to-moderate ascites.  He was given 1 dose of Zosyn and then started on levofloxacin and Flagyl last night.  Dr. X was called early this morning due to hypotension, SBP in the 70s.  He then changed antibiotic regiment to vancomycin and doripenem.