22nd May 2024

A 74-year-old male is referred to the acute medical unit by his GP with lethargy

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever. He is accompanied by his wife. They tell you that he has felt lethargic for 3-4 days and complained of some left flank pain. His GP had commenced Trimethoprim 3 days ago, but this has not helped his symptoms.  He has had rigors, but nil else in terms of positive symptomatology.  He weighs 83 kg, has a history of Type 2 diabetes, benign prostatic hypertrophy and IHD. On review, his GCS is 15. His RR is 23, his saturations are 94% on air. His HR is 132, and his BP is 88/60. He is pyrexial at 38.9. His CRP is 200 mg/dL, WCC 20 x 10⁹/L, platelets 200 x 10⁹/L, urea is 17 mmol/L and creatinine is 299 μmol/L from a baseline of 100. His chest sounds clear. He has had a 250ml fluid bolus and has been catheterised 10 minutes ago but is yet to produce any urine.

What is the most appropriate next step in terms of fluid management?

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