A 76-year-old woman taking perindopril for hypertension and regular ibuprofen for knee osteoarthritis presents after three days of vomiting and watery diarrhoea. She has dry mucous membranes, a pulse of 104/min, and her systolic blood pressure falls 22 mmHg on standing. Blood tests show creatinine 240 micromol/L (45-90; her baseline three months ago was 85), urea 22 mmol/L (2.5-8.0) and potassium 5.3 mmol/L (3.5-5.2). Urinalysis is bland and a bladder scan shows minimal residual volume. In addition to withholding perindopril and ibuprofen, which one of the following is the most appropriate initial management?
More from AMC
See allA 17-year-old girl presents six hours after a deliberate ingestion of tablets taken from the family bathroom cabinet. She complains of nausea, repeated vomiting…
A 28-year-old woman is brought in by ambulance 90 minutes after being found drowsy next to an empty box of amitriptyline. Her Glasgow Coma Scale score is 12, he…
A 21-year-old man collapses at the 14 km mark of a city fun run on a 34°C day. In the trackside medical tent he is confused and agitated with a Glasgow Coma Sca…
A 26-year-old backpacker is snorkelling off Port Douglas in far north Queensland in December when she feels a mild sting on her forearm, leaving only faint redn…
A 34-year-old man in suburban Sydney felt a sharp pinprick on the back of his hand while moving pot plants stacked against the house. Over the next two hours he…