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15th July 2024
A 53-year-old woman presented with acute shortness of breath. She has a history of hypertension and ischaemic heart disease
A 53-year-old woman presented with acute shortness of breath. She has a history of hypertension and ischaemic heart disease with a previous triple vessel coronary artery bypass graft surgery. On examination, she had widespread crackles throughout the lung fields. A chest x-ray confirmed pulmonary oedema. She was commenced on IV furosemide and IV nitrates with good symptomatic improvement. Investigations showed:
| Serum sodium | 137 mmol/L |
| Serum potassium | 4.1 mmol/L |
| Serum urea | 8.6 mmol/L |
| Serum creatinine | 169 µmol/L |
| Random plasma glucose | 10.6 mmol/L |
| Urinalysis | protein ++ |
The next day, she was switched to 80mg of oral furosemide daily and commenced on Ramipril 2.5mg daily. Repeat investigations one week later were as follows:
| Serum sodium | 132 mmol/L |
| Serum potassium | 5.0 mmol/L |
| Serum urea | 14.9 mmol/L |
| Serum creatinine | 231 µmol/L |
| Fasting plasma glucose | 6.1 mmol/L |
Which of these is likely to be responsible for the deterioration in renal function?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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