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31st May 2023
A 75-year-old female presents to ED with a history of severe back pain and constipation
A 75-year-old female presents to ED with a history of severe back pain and constipation. She is noted to be unsteady on her feet by the paramedics and on examination has reduced power in both lower limbs. She has a history of ischaemic heart disease and atrial fibrillation but is normally independent.
Her bloods reveal the following:
| Hb | 84 g/L | (120-170 g/L) | Na | 131 mmol/L | (133-146 mmol/L) |
| WCC | 8.2 x 10⁹/L | (3.6-11 x 10⁹/L) | K | 4.8 mmol/L | (3.5-5.3 mmol/L) |
| Platelets | 215 x 10⁹/L | (150-400 x 10⁹/L) | Urea | 8.6 mmol/L | (2.5-7.8 mmol/L) |
| Albumin | 22 g/L | (35-50 g/L) | Creatinine | 173 µmol/L | (59-104 µmol/L) |
| Total protein | 84 g/L | (60-78 g/L) | eGFR | 26 ml/min/1.73m2 | |
| Adj. Calcium | 2.80 mmol/L | (2.2-2.6 mmol/L) | |||
Which investigation should be prioritised first?
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