14th February 2025

A 22-year-old patient is brought to the emergency department by his mother after not sleeping for 4 days, spending £4,000 on new clothes, and knocking on his neighbours’ doors to tell them he is the son of God.

A 22-year-old patient is brought to the emergency department by his mother after not sleeping for 4 days, spending £4,000 on new clothes, and knocking on his neighbours’ doors to tell them he is the son of God. He has a background of depression and takes regular venlafaxine. His friends regularly smoke cannabis but he has always declined recreational drugs due to his religious beliefs.

His observations in A&E are as follows – HR 109 bpm, RR 15, BP 134/76, Sa02 95% on RA, T 36.7

The following investigations are carried out:

Haemoglobin 156 g/L (130-180)

White Cell Count 10.9 x10^9/L (3.6-11)

Neutrophils 7.2 x10^9/L (1.8-7.5)

Platelet Count 420 x10^9/L (140-400)

Sodium 136 mmol/L (135-145)

Potassium 4.2 mmol/L (3.5-5.3)

Urea 4.5 mmol/L (2.5-7.8)

Creatinine 87 micromol/L (59-104)

eGFR >90

CRP 7 mg/L (<5)

Which of the following is not a first-line management option for the likely underlying cause?

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