2 Days Of Lightheadedness in Medicine / Internal Medicine — 72yo Man | Nephrology | SMLE Q#1051

SMLE Question #1051

Medicine / Internal Medicine Nephrology
Last updated: February 2026
A 72-year-old man with chronic heart failure with reduced ejection fraction presents with 2 days of lightheadedness and generalized weakness. His medications are lisinopril, spironolactone, and furosemide. He is lethargic with cool extremities and flat neck veins. He receives an initial bolus of IV 0.9% sodium chloride. Blood tests and urine indices are obtained and show acute kidney injury. Which of the following is the most appropriate next step in management?

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