A 72-year-old man is brought to the emergency department with 3 days of vomiting and diarrhea. He feels dizzy on standing and has passed very little urine in the past 24 hours. He has hypertension and type 2 diabetes and takes ramipril 10 mg daily, hydrochlorothiazide 25 mg daily, metformin 1000 mg BID, empagliflozin 10 mg daily and atorvastatin 20 mg daily; for the past 2 days he has also taken over-the-counter ibuprofen for body aches. On examination, he has dry mucous membranes and reduced skin turgor, with no edema and clear lungs. Creatinine is 210 umol/L (60-110; 90 six months ago), urea 18.5 mmol/L (2.5-8.0), potassium 5.6 mmol/L (3.5-5.0), bicarbonate 20 mmol/L (22-29) and glucose 8.1 mmol/L; capillary ketones are negative. ECG shows sinus tachycardia without T-wave changes, bladder scan shows a residual volume of 30 mL, and urinalysis is bland.
| Heart rate | 105/min |
| Respiratory rate | 18/min |
| Temperature | 36.8 °C |
| O2 saturation | 97%, room air |
| Blood pressure | 90/55 mm Hg |
Question 1 of 3
Which of the following are the most appropriate initial management steps?
Select 2. (0 / 2 selected)
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