A + E 1

You are now the FY1 doctor on the medical team at St George's Hospital, and your registrar has asked you to see Mr Hunt, who has been admitted with a history of acute confusion, and a fall at home. You obtain a brief history of recent events from Mr Hunt's daughter and the FY2 GP who has recently seen him.

The nurse who is looking after him has done some baseline observations and has obtained a urine sample (with some difficulty as she says he was very agitated).

Urine:

• Leucocytes +++

• Nitrites +

• Blood ++

• Protein, +++

• pH 5, Ketones +

Observations:

• BP 131/73

• HR 105

• RR 27

• SaO2 97% on air

• Temp: 38.0oc

The urine dip confirms Mr Hunt has a urinary tract infection.