Author: Tay Xue Chao Brian Diaz / Editor: Steve Corry-Bass / Reviewer: Anoop Chidambaram / Codes: NepC1, NepC5, NepP2, SLO1, SLO3 / Published: 27/12/2023

An 80-year-old gentleman with known heart failure presents with a 3-day history of shortness of breath, coughing-up green sputum, and feeling generally unwell.

On examination, you hear crackles on both lung bases with those on the right sounding markedly louder than the left. His feet are also slightly oedematous. His abdomen is soft and non-tender on palpation, not distended, and he has no dysuria. He’s also not confused.

His observations are as follows: Heart rate 120/min, Respiratory rate 30/min, Temperature 39oC, Blood pressure 100/55, Capillary refill time 2 seconds. On direct questioning, he hasn’t passed any urine in over 12 hours. You request a sample and he manages to give you one in a bottle. You pour it out into a sample pot and it measures 50mls. You dip the urine and get the following result.  Urinalysis shows Glucose negative, Bilirubin negative, Ketone trace, Blood negative, pH 6.0, Protein +, Nitrite +, Leukocytes +++.

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