MRCP2-4050

MRCP2-4050

A 65-year-old male Jehovah’s witness presents to the hospital with increasing fatigue and malaise over the past 4 weeks. He has been bedridden for the past day. The patient has a medical history of stage 5 chronic kidney disease, hypertension, and type 2 diabetes. Despite his kidney disease, he is still able to pass urine without renal replacement therapy, with a baseline creatinine of 260 µmol/l. Upon examination, he appears warm peripherally with conjunctival pallor. His heart sounds are normal, his chest is clear, and his abdomen is soft and non-tender. He has passed 800mls of urine in the last 24 hours. The following are his blood test results:

Hb 80 g/l
Platelets 201 * 109/l
WBC 6.7 * 109/l
Ferritin 4 ng/ml
Transferrin saturation 19%

Na+ 145 mmol/l
K+ 4.9 mmol/l
Urea 17.7 mmol/l
Creatinine 276 µmol/l

What is the most appropriate course of action?