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.
Hb 12 g /dL
WBC 19.5 x109 /L
Platelets 350 x109 /L
Urea 22 mmol/L
Creatinine 200 Ámol/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?