24th April 2024

A 67-year-woman from London who is visiting relatives in Manchester presents unwell to the emergency department.

A 67-year-woman from London who is visiting relatives in Manchester presents unwell to the emergency department. She has been nauseous and vomiting with a headache and reports yellowing blurry vision. On further questioning she reveals general fatigue and weight gain over the past month. Her past medical history is significant for atrial fibrillation and she has recently completed a course of antibiotics prescribed for a urinary tract infection. She does not have her medication list with her but can tell you one of her medicines is to control her heart rate. You are unable to find anything on her GP care record but you suspect drug toxicity may be the cause of her symptoms. You request bloods including renal function and an ECG. Which of the following factors is least likely to contribute to this presentation? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.