51 year-old man with multiple sclerosis, quadriparesis, hypertension, restrictive lung disease, chronic constipation and small bowel obstruction after ileostomy, multiple urinary tract infections (also after placement of suprapubic tube), presents with small bowel obstruction and urinary tract infection. Admitted today as his home health aide noticed his urine output was low, 75cc overnight when he usually has about 1 liter overnight. Over the past two weeks he has had mild earaches, a sorethroat as well as some rhinorrhea. He denies any abdominal pain, has not sujectively noticed any change in abdominal distention. In the Emergency Department, he was noted to be severely dehydrated on exam, and creatinine level was 1.4 up from 0.6.