Physician's Assistant

Patient Details

Refined clerking (39 days ago 13:05)

Refined clerking Thu 26 February 2026 13:05

Last Modified: 39 days ago

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Medical ST5 Miller Clerking
Date: 26/02/2026 13:05

Presenting Complaint:
Hyperkalaemia and acute kidney injury

History of Presenting Complaint:
An 89-year-old gentleman presented to the Emergency Department and was brought to the resuscitation area following abnormal blood test results demonstrating hyperkalaemia and acute kidney impairment. He has been feeling generally unwell for approximately 3–4 months, with lethargy. He denies any abdominal pain, fevers, rigors, cough, or coryzal symptoms.

With regard to his urinary symptoms, he reports passing only small volumes of urine, never feeling completely empty, and needing to return to void within 10 minutes of each attempt. He denies any significant change in these symptoms recently, stating this pattern has been longstanding in the context of his known prostate cancer. A urinary catheter is in situ, draining small but present volumes.

He has known prostate cancer with previous evidence of pelvic nodal involvement. He received hormonal therapy previously but this was discontinued after being told no further disease-modifying treatment was available.

Social History:
Lives in a house in Paignton with his wife (aged 90) and has support from his daughter and son.
Mobilises independently within the home without aids. Uses a walking stick on uneven outdoor terrain.
Occupation: Previously worked as a volunteer wayfarer (patient welfare/wayfinding) at the hospital for approximately 7 months.
Able to walk outdoors daily when weather permits, including to a local park. Wife drives.

On Examination:
General Appearance: Alert and conversational. Tongue noted to be dry on inspection and reduced skin turgor
Nil to find on examination of heart and lungs.

Impression:
Acute kidney injury with secondary hyperkalaemia, likely in the context of advanced prostate cancer with possible obstructive uropathy

Management Plan:
1. Cardiac monitoring
2. CT KUB
3. Bilateral Iv access
4. Medical management of hyperkalaemia
5. Strict fluid balance monitoring via urinary catheter.
6. If obstructive uropathy confirmed on CT: urology review regarding feasibility and appropriateness of ureteric stenting or nephrostomy

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Refined clerking Thu 26 February 2026 13:05

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