An 82 year old white male presents in the ER with hypersomulance, new onset of confusion, and severe anorexia. His health has been failing for the past two months. At baseline, is described as active, highly functional and mentally sharp. Past medical history includes hypertension. He oral temperature is 97.8 degrees, R=20, P=90. Exam shows heart sounds regular, dry crackles in lung bases, bilaterally, abdomen soft without any tenderness, extremities without edema. Chest x-ray is unchanged from a prior exam, UA shows + 3 bacteria, positive nitrites but no pyuria. Serum WBC is only 8,000.