▸ Consider blood transfusion (checking ferritin, transferrin saturation, RBC folate and vitamin B₁₂ before transfusion).

▸ If iron deficient: consider iron supplements and coeliac screen (ie tissue transglutaminase and IgA levels), OGD, SI biopsy, colonoscopy and renal tract evaluation.

▸ Check ferritin, transferrin saturation, RBC folate and vitamin B₁₂. Replace if necessary, monitor response. If unexplained consider coeliac screen, OGD, SI biopsy and colonoscopy and renal tract evaluation.

▸ If anaemia is unexplained, refer to haematology.

▸ Urine dipstix.

▸ Discuss with supervising clinician within 24 hours.

▸ Consider appropriate intravenous fluid therapy/oral replacement.

▸ If K⁺ <3 mmol/L or >6 mmol/L, this is an emergency.

▸ If Na⁺ <120 or >150 mmol/L, this is an emergency.

▸ Discuss with supervising clinician within 24 hours.

▸ Check thyroid function

▸ Patient will need a liver ultrasound and liver screen including hepatitis A, B, C and E serology, EBV and CMV, ferritin, α feta protein, α 1 antitrypsin, coeliac serology, liver autoantibodies, total Igs, cholesterol, triglycerides, caeruloplasmin (<50 years old only).

▸ Refer for further evaluation to a hepatologist.

▸ If no history of diabetes:

• Between 7–11 mmol/L: refer to GP.

• >11 mmol/L and ketones in urine: this is an emergency.

• >11–20 mmol and no ketones in urine: discuss with supervising clinician within 24 hours.

• >20 mmol/L and no ketones in urine: this is an emergency.

▸ If 2.6–2.9 mmol/L: discuss with supervising clinician within 24 hours.

▸ If <1.8 mmol/L or >3.0 mmol/L: this is an emergency.

▸ Check parathyroid hormone levels.