Description

A 75 year old man presented with a two week history of
f lu-like symptoms for which he was on co-amoxiclav,
and a four-day history of anorexia, weakness and
epigastric pain. He had a seven-year history of
Type II diabetes mellitus which was suboptimally
controlled (HbA1c 7.5%), with metformin 500 mg
BD and gliclizide 80mg. Other significant conditions
included: bladder tumour resection with ureterostomy
bag, horse-shoe kidney with bilateral dilated calyces,
hypercholesterolaemia, hypertension, and he was
overweight (BMI of 29). Medications included:
metformin 500 mg BD, aspirin 75 mg, ramipril
5 mg, felodipine 10 mg, atenolol 50 mg, atorvastatin
20 mg daily. Examination revealed cold peripheries,
marked clinical dehydration, epigastric tenderness,
bradycardia 4050/minute and BP of 97/64 mmHg.
ECG revealed tented T-waves and a broad QRS
complex. Initial investigations showed the following:

Statistics, with questions and answers to follow.