Critical illness
A 76-year-old man develops an acute kidney injury 2 days after an elective knee replacement. His past medical history includes mild chronic obstructive pulmonary disease and hypertension (controlled with an angiotensin-converting enzyme (ACE) inhibitor). He is hypotensive (80/50 mmHg), oliguric and has urea of 18 mmol/L (50.4 mg/dL), creatinine of 165 μmol/L (1.87 mg/dL), potassium of 5.1 mmol/L, and a normal bicarbonate level. He has received 30 mL/kg of intravenous fluids over the past 2 hours. Which will be the most efficacious measure to improve his renal outcome?
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