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4 Nov 2016 - General

An elderly lady, with background of Ischaemic heart disease, congestive heart failure, chronic kidney disease, hypertension, previous stroke, and type 2 diabetes mellitus, was admitted to hospital due to increasing short of breath on very minimal exertion for the pass 3 days, also with the symptoms of orthopnoea. She denied any chest pain, no productive cough, no wheezing, no fever or rigor, and no urinary symptoms. Her regular medication included, aspirin, frusemide 40mg OD, lisinopril, amlodipine, and metformin. On examiantion, her oxygen saturation was around 88-89% on room air, with respiratory rate of around 22 per minutes, with fine bi-basal crepitations on both lung field, increased JVP, and bi-lateral pitting ankle oedema. Chest x-ray showed pulmonary oedema. No ischaemic changes in the ECG. Her renal function showed that she was having acute kidney injury as well, creatinine from the baseline of around 140, increased to around 190, with eGFR drop to around 15. What is your diagnosis, and what will be your management plan ???