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BOF: 79

A 75 year old male is admitted with a history of confusion. There was a history of being generally unwell and having a dry cough for several months prior to admission. He was known to have hypertension and was on a thiazide diuretic. He smoked 30 cigarettes a day and had done so for the last 60 years.

On examination he looked unwell, was confused, skin turgor was diminished, pulse 110 beats per minute BP 110/70 lying 80/50 standing.

Investigations

Hb 12 g /dL

WBC 19.5 x10⁹ /L

Platelets 350 x10⁹ /L

Urea 22 mmol/L

Creatinine 200 µmol/L

Sodium 140 mmol/l

Potassium 4.8 mmol/L

Corrected Calcium 3.3 mmol/L

Phosphate 1.3 mmol/L

In this patient which one of the following would be your initial line of management?

a)      Saline infusion

b)      Dextrose infusion

c)      Intravenous furosemide

d)     Intravenous bisphosphonate

e)      Intravenous steroid

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