1. Abnormalities: the abnormalities are that the urea and creatinine are both raised.

The urea is
proportionally more raised than the creatinine which may indicate dehydration is more likely.

Plausible reasons would include:

• Dehydration
• Acute renal failure
• Chronic renal failure (as we don’t know his previous renal function)
• Gastrointestinal bleeding
• Drug related

2. Plausible reasons: the urea is elevated proportionately more than the raised creatinine, the
commonest cause for this is dehydration, particularly when the sodium is high normal. This fits with
the clinical history you have as well. This is something you will see commonly on the wards. Other
causes, such as renal impairment, need to be considered but there are no other pointers towards
this. Sepsis is also plausible: there is no evidence for any other causes.

3. The most appropriate initial corrective measure in this case is intravenous hydration. This needs
to be IV as he is not drinking and his blood results are deranged significantly. Saline or Hartmann’s
are a good choice; dextrose is not appropriate for rehydration. Monitor the effect by observing urine
output, pulse and BP and checking U&Es. Any other management is inappropriate e.g. dialysis.
Diuretics are contraindicated as he is dehydrated.