10th September 2020

A delirious 79-year-old man presents to the emergency department with a 3-day history of fever

A delirious 79-year-old man presents to the emergency department with a 3-day history of fever, dyspnoea and a worsening purulent productive cough. He is on ramipril for hypertension and metformin for type 2 diabetes. His basic observations are: T 38.4, Oxygen saturations 91%, RR 28, HR 120, BP 95/55. On examination, there is reduced air entry and a dull percussion note in the right middle and lower lobes with associated crackles. Blood tests show an AKI stage 2, sodium 133 (135-145), potassium 5.8 (3.5-5), urea 11.5 (2-7) and CRP 110. FBCs and LFTs are normal. He is diagnosed with community-acquired pneumonia. 

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