2nd August 2023

A 67 year old woman presents having collapsed. She is found to have a blood glucose of 2.1, with no history of diabetes.

A 67 year old woman presents having collapsed. She is found to have a blood glucose of 2.1, with no history of diabetes. On further examination, she is found to have suprapubic fullness, and a subsequent bladder scan reveals urinary retention, which is relieved through catheterisation. The urine looks almost completely black.

Blood tests show metabolic acidosis and AKI stage 2. Collateral history from the daughter reveals a 6 day history of progressively worsening fevers and fatigue, and that she had recently returned from a trip to India.

What is the first line treatment for the diagnosis?

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