INTRODUCTION: COVID-19 infection has varied presentations and complications inclusive of pneumonia(PNA),gastroenteritis(GE) and Acute kidney injury(AKI).Prompt identification with aggressive therapy is needed to reduce morbidity and mortality.We present a case of COVID-19 infection with septic shock and severe AKI,successfully treated CASE PRESENTATION: A 65-year-old female presented with 7-days of vomiting,diarrhea,fever,dry cough,fatigue & confusion.Multiple household members had recently tested positive for SARS CoV-19.She had a history of localized breast cancer on tamoxifen,HTN and CKD3a.Baseline creatinine(Cr) 3 months prior was 1.2.On exam,BP was 86/48mm/hg, T 95F,RR 27 breaths/ min.She had dry mucous membranes, coarse breath sounds & rales bilaterally on auscultation,confusion & flapping wrist tremor.Significant labs were a Cr of 21.5,BUN 162, CO2 9,D-dimer >20,CRP 55 & random urine protein on 19 (<12mg/dl).ABG on 3L nasal cannula showed PH 7.21, PO2 104, PCO2 30.CXR noted right upper lobe infiltrate.CT head and EEG were unremarkable.SARS-CoV-2 PCR was positive.She was transferred to ICU for management of septic shock from COVID-19 PNA & GE with severe AKI.Despite aggressive IV fluids,she remained hypotensive requiring phenylephrine for pressor support.She received IV D5

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