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Original Question
Scenario: Derek Bonner, a 72 year old Aboriginal male, has been on your ward for the past day with Acute on Chronic Kidney Injury secondary to a recent vomiting and diarrhea after food poisoning. Derek has a past history of CKD, Type 2 Diabetes Mellitus, ex smoker, increased BMI, and hypertension. In your morning handover it is revealed that he hasn’t had anything to eat for a few days and his IVT insitu of 5% Dextrose (1 Litre) at an 8/24 rate was changed to a normal saline flask at the same rate at 0300 hours. According to Derek’s Electronic Medical Record his last episode of vomiting and diarrhea was at 0100 hours and he received his oral hypoglycaemics at 0600 together with his daily subcutaneous enoxaparin. It is 0730 hours and when you go to Derek’s room he complains to you of a headache, weakness and blurred vision. Your initial primary assessment reveals: A: Airway clear B: Equal chest movement, no use of accessory muscles, RR 22 C: Diaphoretic, tachycardia D: Drowsy, GCS 13/15 E: Not performed Vital signs reveal: HR: 126 bpm; irregular BP: 140/85 RR: 22 breaths/min T: 36.8 SpO2: 96% What clinical impression, together with signs and symptoms, is Derek presenting with that formed your impression of the condition you believe he is now suffering from and why do these signs & symptoms occur (underlying pathophysiology)? With references
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