7th September 2020

A 76-year-old man with a known history of multiple myeloma presents to the emergency department with subacute onset vomiting and general malaise

A 76-year-old man with a known history of multiple myeloma presents to the emergency department with subacute onset vomiting and general malaise, with a history of bilateral leg swelling over the last week. He has a serum creatinine of 500umol/L (normal range 50-120umol/L). His urine volume was <30 mL/h for the previous 3 hours and his ABG shows he is hyperkalaemic. Prior blood tests from 4 weeks ago demonstrated that his serum creatinine was 150umol/L.

For the patient above, please select the SINGLE most appropriate initial treatment option. Select ONE option from the list above.