مسنة عمرها ٨٠ سنة تأخذ فوروسيميد وليزينوبريل، عندها إسهال وقيء من ٣ أيام، وتأكل وتشرب قليلاً. اليوم صارت ضعيفة جداً ومشوشة. الضغط ٨٦/٥٢، النبض ١١٢، الكرياتينين ضعف قيمته السابقة، والبوتاسيوم ٢٫٨. أي إجراء مع السوائل الوريدية؟

An 80-year-old woman on furosemide and lisinopril has had diarrhoea and vomiting for 3 days with poor intake. Today she is very weak and confused. BP 86/52, HR 112, creatinine double baseline, potassium 2.8. Which action accompanies IV fluids?

1. Restrict fluids for fear of fluid collecting in the lungs
2. Increase the furosemide dose to improve kidney function
3. Temporarily hold furosemide and lisinopril as ordered and replace potassium
4. Give a strong antidiarrhoeal and continue all usual medicines

Answer: C) Temporarily hold furosemide and lisinopril as ordered and replace potassium. Diarrhoea and vomiting with a diuretic and ACE inhibitor cause dehydration, AKI and hypokalaemia. Hold these drugs temporarily (sick-day rules), give fluids and replace potassium with monitoring.