Hyperosmolar hyperglycemic stateDownloads

A 62-year-old man presents to the emergency department with confusion. The patient’s wife states that her husband has become more somnolent over the past several days and now is very confused. The patient has no complaints himself, but is answering questions inappropriately. The patient has a past medical history of diabetes and hypertension. His temperature is 98.3°F (36.8°C), blood pressure is 127/85 mmHg, pulse is 138/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused man with dry mucous membranes. Initial laboratory studies are ordered as seen below. Serum: Na+: 135 mEq/L Cl-: 100 mEq/L K+: 3.0 mEq/L HCO3-: 23 mEq/L BUN: 30 mg/dL Glucose: 1,299 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most appropriate initial treatment for this patient?

A 30-year-old woman comes to the physician because of increased urinary frequency over the past month. She also reports having dry mouth and feeling thirsty all the time despite drinking several liters of water per day. She has not had any weight changes and her appetite is normal. She has a history of obsessive compulsive disorder treated with citalopram. She drinks 1–2 cans of beer per day. Her vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies show: Serum Na+ 130 mEq/L Glucose 110 mg/dL Osmolality 265 mOsmol/kg Urine Osmolality 230 mOsmol/kg The patient is asked to stop drinking water for 3 hours. Following water restriction, urine osmolality is measured every hour, whereas serum osmolality is measured every 2 hours. Repeated laboratory measurements show a serum osmolality of 280 mOsmol/kg and a urine osmolality of 650 mOsmol/kg. Which of the following is the most likely diagnosis?