8th July 2024

A 48-year-old male presents with lethargy, arthralgia and poor urine output for the last week

A 48-year-old male presents with lethargy, arthralgia and poor urine output for the last week. He is known to have hepatitis C, for which he is on antiviral treatment. He was recently treated with flucloxacillin for an infected leg ulcer.

On clinical examination, he has splenomegaly but no ascites. U&Es were unremarkable 3 weeks ago.

Investigations today show: Hb 90 g/L (115-165), WBC 12.4×10⁹/L (4-11), Neutrophils 9.3×10⁹/L (2-8), Platelets 120×10⁹/L (150-400), Na 130 mmol/L (135-145), K 4.2 mmol/L (3.5-5), Urea 9.4mmol/L (2.5-7.5), Creatinine 198 μmol/L (60-110), CRP 15 mg/L (<5),. Bilirubin 32 μmol/L (<21), ALT 80 U/L (<41), ALP 120 U/L (30-130). Urine Dipstick is negative for protein and blood. What is the most appropriate initial treatment in this case?

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