29th February 2024

You are a FY1 currently working on the elderly care ward, taking part in the ward round.

You are a FY1 currently working on the elderly care ward, taking part in the ward round. Mrs Smith is a 87-year-old retired shop worker who was admitted with a community acquired pneumonia 5 days ago. Her past medical history includes an MI at age 65, hypertension and type 2 diabetes. Today on the ward round, she is feeling much better and denies any cough, shortness of breath or temperatures. She is complaining of leg weakness. On examination, her chest is clear. Her saturations are 97% on air, HR 78 bpm, RR 14 bpm and BP 138/87 mmHg. Her blood tests from yesterday are back from the lab:

Hb 126 g/L (115-160 g/L)

WCC 9 x1012/L (4-11 x1012/L)

Platelets 324 x109/L (150-400 x109/L)

CRP 13 mg/L (<5 mg/L)

Na 138 mmol/L (135-145 mmol/L)

K 5.4 mmol/L (3.5-5 mmol/L)

Urea 6.6 mmol/L (2.5-6.7 mmol/L)

Creatinine 78 μmol/L (70-150 μmol/L)

eGFR >90 mL/min/1.73m2 (>90 mL/min/1.73m2)

Which one of Mrs Smith’s medications is most likely to cause this lab finding?