A 61-year-old female with congestive heart failure and type 2 diabetes is brought to the emergency room by her husband because of an altered mental status. He states he normally helps her be compliant with her medications, but he had been away for several days. On physical exam, her temperature is 37.2 C, BP 85/55, and HR 130. Serum glucose is 500 mg/dL. Which of the following is the first step in the management of this patient?
AIV ½ NS
BIV insulin
CSubcutaneous insulin injection
DIV NS
EIV D5W
A 45-year-old woman comes to the physician because of a 3-month history of worsening fatigue, loss of appetite, itching of the skin, and progressive leg swelling. Although she has been drinking 2–3 L of water daily, she has been passing only small amounts of urine. She has type 1 diabetes mellitus, chronic kidney disease, hypertension, and diabetic polyneuropathy. Her current medications include insulin, torasemide, lisinopril, and synthetic erythropoietin. Her temperature is 36.7°C (98°F), pulse is 87/min, and blood pressure is 138/89 mm Hg. She appears pale. There is 2+ pitting edema in the lower extremities. Sensation to pinprick and light touch is decreased over the feet and legs bilaterally. Laboratory studies show: Hemoglobin 11.4 g/dL Leukocyte count 6000/mm3 Platelet count 280,000/mm3 Serum Na+ 137 mEq/L K+ 5.3 mEq/L Cl− 100 mEq/L HCO3− 20 mEq/L Urea nitrogen 85 mg/dL Creatinine 8 mg/dL pH 7.25 Which of the following long-term treatments would best improve quality of life and maximize survival in this patient?
APeritoneal dialysis
BLiving donor kidney transplant
CCadaveric kidney transplant
DHemofiltration
EFluid restriction
A 23-year-old man presents to the emergency department for altered mental status after a finishing a marathon. He has a past medical history of obesity and anxiety and is not currently taking any medications. His temperature is 104°F (40°C), blood pressure is 147/88 mmHg, pulse is 200/min, respirations are 33/min, and oxygen saturation is 99% on room air. Physical exam reveals dry mucous membranes, hot flushed skin, and inappropriate responses to the physician's questions. Laboratory values are ordered as seen below. Hemoglobin: 15 g/dL Hematocrit: 44% Leukocyte count: 8,500/mm^3 with normal differential Platelet count: 199,000/mm^3 Serum: Na+: 165 mEq/L Cl-: 100 mEq/L K+: 4.0 mEq/L HCO3-: 22 mEq/L BUN: 30 mg/dL Glucose: 133 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L Which of the following is the best next step in management?
ALactated ringer
BHypotonic saline
C50% normal saline 50% dextrose
DNormal saline
EDextrose solution
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