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4th April 2024
An 88-year old female presents to the emergency department with reduced consciousness.
An 88-year old female presents to the emergency department with reduced consciousness. She lives alone but was found by her daughter in the morning. Her past medical history includes pre-diabetes and hypertension.
Her daughter informs you she has been complaining of fatigue and lower back pain, which has been progressively worse for the last 3 months. She has been struggling to walk to and from her local shop, something she was previously able to do independently.
Over the last week, she has been complaining of increased urinary frequency but no dysuria. Her daughter notes that she appeared slightly confused when they last spoke 2 days ago.
On examination, she has reduced skin turgor and dry mucous membranes. Her GCS is 12 (E3, V4, M5).
An ECG is performed, which shows a QT interval of 354ms. Her urine dipstick was negative for nitrites, leucocytes, ketones and protein. Her blood results are shown below.
| Result | Reference Range | |
|---|---|---|
| Hb | 88 g/L | 115-160 g/L |
| MCV | 91 fl | 82-100 fl |
| WCC | 7.2 x 109/L | 4.0-11.0 x 109/L |
| Na | 137 mmol/L | 135-145 mmol/L |
| K | 4.1 mmol/L | 3.5-5.0 mmol/l |
| Cr | 160 umol/L | 55-120 umol/l |
| Urea | 7.4 mmol/L | 2.0-7 mmol/l |
| eGFR | 59 ml/min/1.73m² | >90 ml/min/1.73m² |
| AdjCa | 3.4 mmol/L | 2.1-2.6 mmol/L |
| Phosphate | 0.69 mmol/L | 0.8-1.4 mmol/L |
| PTH | 0.1 pmol/L | 0.9-5.4 pmol/L |
| HbA1c | 44 mmol/mol | <48 mmol/mol |
What is the most appropriate initial treatment for this patient?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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