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18th July 2023
A 67-year-old man presents to hospital with ‘black stools’, shortness of breath and fatigue
A 67-year-old man presents to hospital with ‘black stools’, shortness of breath and fatigue. He has a past medical history of type 2 diabetes mellitus, hypertension, and a previous TIA (4 months ago). On examination, his peripheries are cold to touch, and capillary refill is 4 seconds. You perform a PR examination which reveals melaena with no evidence of fresh red blood.
His observations are listed below:
- Temperature 36.4oC
- Heart Rate 110
- Blood Pressure 92/50
- Respiratory Rate 24
- Oxygen saturation 94% RA
His blood tests are listed below:
| Haemoglobin | 78 | 130 – 180 g/L | ALT | 16 | <41 U/L |
| White cell count | 10.2 | 4.5 to 11.0 × 10⁹/L | ALP | 105 | 30–130 U/L |
| Platelets | 482 | 140 – 400 x10⁹/L | Albumin | 34 | 35–50 g/L |
| Urea | 12.4 | 2.5 – 7.8 mmol/L | Bilirubin | 20 | <21 μmol/L |
| Creatinine | 63 | 59–104 μmol/L | Chloride | 102 | 98-106 mmol/L |
He had a similar presentation of melaena with a haemoglobin of 72 g/L 2 months ago. An OGD and colonoscopy performed at the time were normal.
Following resuscitation, what is the next most appropriate management step?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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