A 7-day-old male infant presents to the pediatrician for weight loss. There is no history of excessive crying, irritability, lethargy, or feeding difficulty. The parents deny any history of fast breathing, bluish discoloration of lips/nails, fever, vomiting, diarrhea, or seizures. He was born at full term by vaginal delivery without any perinatal complications and his birth weight was 3.6 kg (8 lb). Since birth he has been exclusively breastfed and passes urine six to eight times a day. His physical examination, including vital signs, is completely normal. His weight is 3.3 kg (7.3 lb); length and head circumference are normal for his age and sex. Which of the following is the next best step in the management of the infant?
AReassurance of parents
BEvaluation of the mother for malnutrition
CAdmission of the infant in the NICU to treat with empiric intravenous antibiotics
DEmphasize the need to clothe the infant warmly to prevent hypothermia
ESupplementation of breastfeeding with an appropriate infant formula
A 7-year-old boy is brought to the emergency room because of severe, acute diarrhea. He is drowsy with a dull, lethargic appearance. He has sunken eyes, poor skin turgor, and dry oral mucous membranes and tongue. He has a rapid, thready pulse with a systolic blood pressure of 60 mm Hg and his respirations are 33/min. His capillary refill time is 6 sec. He has had no urine output for the past 24 hours. Which of the following is the most appropriate next step in treatment?
AStart IV fluid resuscitation by administering colloid solutions
BProvide oral rehydration therapy to correct dehydration
CGive initial IV bolus of 2 L of Ringer’s lactate, followed by packed red cells, fresh frozen plasma, and platelets in a ratio of 1:1:1
DStart IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output
EGive antidiarrheal drugs
A 42-year-old man is brought to the emergency department by his wife because of a 1-day history of progressive confusion. He recently lost his job. He has a history of chronic alcoholism and has been drinking 14 beers daily for the past week. Before this time, he drank 6 beers daily. He appears lethargic. His vital signs are within normal limits. Serum studies show a sodium level of 111 mEq/L and a potassium level of 3.7 mEq/L. Urgent treatment for this patient's current condition increases his risk for which of the following adverse events?
AWernicke encephalopathy
BOsmotic myelinolysis
CCerebral edema
DCardiac arrhythmia
EHyperglycemia
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