What would you do next? True or false.
Fluid assessment - to determine if patient is hypovolaemic, euvolaemic or overfilled. Prescribe fluids if required
Consider catheter - Has Mrs Brown managed to pass urine since admission? Does she have a palpable bladder? Volume in bladder on bladder scan? Is she able to mobilise to commode/toilet?
Review old blood test results - useful to know baseline creatinine and urea - is the renal impairment longstanding or new?
Give IV antibiotics - no source of infection identified, not clinically septic. Hold off currently but would perform a septic screen to exclude infection e.g. urine culture, CXR, blood cultures if pyrexial
Monitor urine output - to assess if oliguric / anuric
Urine dip - to help determine underlying cause e.g. blood +++ and protein ++++ suggest intrinsic glomerular disease
Renal tract ultrasound - to exclude obstruction and to confirm presence of two kidneys and measure size of kidneys
ECG - heart rate slow 41bpm, even though patient is on beta blocker still quite slow and would want to know underlying rhythm
Chest x-ray - as part of septic screen and to help with establishing fluid status
Acute renal immunology screen - may not be necessary as identifiable causes for AKI
Abdominal x-ray - no indication to do
Myeloma screen - she has back pain and AKI