Question 1

You are on a busy night shift covering the medical wards of a district general hospital.

A bleep has come through from the elderly care unit. Nursing staff are requesting re-prescription of maintenance fluids for Lorna, a 93-year-old woman awaiting nursing home placement.

When you arrive on the ward, the nurse in charge informs you that Lorna has been off her food for the past few days, and has been generally more withdrawn and sleepy. You are reassured that her early-warning score (EWS) has been “basically normal” during this time.

You notice in Lorna’s medical notes that the day team requested a full confusion screen, including urinalysis. However, a urine sample has not been obtained, because Lorna has yet to use the toilet today.

You take a full set of bloods and a VBG, which is shown below:

Which of the following is the most appropriate initial fluid prescription for Lorna?