Case Presentation: A 91-year-old male with a known history of benign prostatic hyperplasia (BPH), diastolic heart failure, pulmonary embolism, hypertension, and previous extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) urinary tract infection (UTI) presented with encephalopathy. He was not tachypneic nor tachycardic, but his bicarbonate was low at less than 8, and his lactic acid [...]