12th January 2024

A 48-year-old woman is on the Respiratory Ward being treated for community-acquired pneumonia.

A 48-year-old woman is on the Respiratory Ward being treated for community-acquired pneumonia. She was admitted 8 days ago and has remained on the same antibiotic regime since. It has been noticed on the morning ward round that the patient appears to have some scleral icterus. Blood tests are therefore taken, which show the following:

Hb 128 g/L (115-165)

WCC 8.2 x 10*9/L (4.0-11.0)

Serum sodium 137 mmol/L (133–146)

Serum potassium 4.1 mmol/L (3.5–5.3)

Bilirubin 109 µmol/L (<21)

ALT 82 U/L (<41)

ALP 456 U/L (30–130)

Urea: 6.1 mmol/L (2.5 – 7.8 mmol/L)

CRP 64 mg/L (<10)

Which of the following agents is most likely to be responsible?

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