A 65 year old male presents to emergency department with a one week history of nausea and lethargy. He reports having consulted his GP early into his symptoms, for which he was given a course of antibiotics. He reports that his symptoms have not improved. The emergency physician sends blood work and the patient’s creatinine comes back at 18mg/dl with urea of 42mmol/L and K of 6.8. Patient is referred to Critical care for urgent dialysis. On further probing by the critical care team, patient reports history of occasional chills over the past one week and has also noticed that his urine output may have been lower than normal. The critical care physician places a probe on the patient’s abdomen and this is what he sees:
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