20th July 2023

A 67-year-old woman presents to the emergency department with nausea, sweating, restlessness, and difficulty sleeping.

A 67-year-old woman presents to the emergency department with nausea, sweating, restlessness, and difficulty sleeping. She has a past medical history of hypertension, chronic kidney disease stage 3b, depression and gout.

Her drug history is as follows: Ramipril 5mg, bendroflumethiazide 2.5mg, allopurinol 100mg. She had previously been taking sertraline 100mg, however she stopped taking this three days ago.

Her heart rate is elevated at 113bpm, all other observations are normal. Blood tests including a full blood count, liver profile, thyroid profile, CRP, and troponin, are all normal. Her renal function is stable compared with results from 2 months previously.

What is the most likely cause of her symptoms?

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