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PLAB03-130

A 68 year old male is admitted to hospital with a productive cough and fever. Chest x-ray reveals a left sided pneumonia. He is delirious and unable to give a clear history but on examination dry mucous membranes are noted. His daughter says he has no significant medical history other than Hypertension and takes Amlodipine for this. He is allergic to Penicillin. He has only passed urine once all day and is unable to produce a urine sample. On further questioning he admits having some palpitations earlier in the day.

Observations:

Heart rate 95 bpm

Temperature 37.5 °C

Respiratory rate 18

Saturations 97% on air

Blood pressure 105/70 mmHg

Initial bloods reveal:

Haemoglobin 110g/L

Serum sodium 137 mmol/l

Serum potassium 6.7 mmol/l

Serum urea 13.5 mmol/l

Serum creatinine 180 µmol/L

CRP 50

High sensitivity troponin – normal

ECG is unremarkable

What is the next most appropriate step in management?

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