MRCP2-3947

MRCP2-3947

A 83-year-old woman is admitted to the general medicine ward due to vomiting and diarrhea for 48 hours. She has a medical history of osteoarthritis and hypertension and is taking the following medications:

– Paracetamol 1 g qds po
– Ibuprofen 400 mg tds po
– Ramipril 2.5 mg od po
– Zopiclone 3.75 mg od po

During the examination, she appears unwell with a temperature of 37.2°C, pulse of 95, and blood pressure of 90/50 mmHg. Her oxygen saturation on air is 92%. Her jugular venous pressure is difficult to visualize while lying flat. Her abdomen is soft, and her respiratory examination and chest x-ray are normal.

The nurses report that she has not passed urine four hours into admission. Some of her blood test results are as follows:

– Haemoglobin 13.3 g/dL (13-18)
– White cell count 11 ×109/L (4-11)
– Urea 15 mmol/L (2.5-7.5)
– Creatinine on admission 150 µmol/L (60-110)
– Creatinine 3 months ago 80 µmol/L (60-110)

What is the best next step in managing this patient?