USMLE Forum Archives - USMLE Step 3 - electrolytes
electrolytes
bingousmle - 07-15-10 01:17
A 52-year-old woman presents to the emergency department after experiencing 4 days of worsening mental status. She has not seen a doctor in over 20 years. Her medical history is unremarkable. She takes no medications. Physical examination shows a somnolent, obese woman with dry mucous membranes. The neurological examination is nonfocal. Results of laboratory studies are as follows: sodium concentration, 128 mEq/L; potassium concentration, 4.5 mEq/L; chloride concentration, 94 mEq/L; serum glucose level, 810 mg/dl; renal function, normal. Which of the following would be the most appropriate intervention in the care of this patient?
A. Fluid restriction and loop diuretics
B. Administration of hypertonic saline
C. Administration of normal saline and insulin
D. Demeclocycline
E none
bingousmle - 07-15-10 01:17
A 52-year-old woman presents to the emergency department after experiencing 4 days of worsening mental status. She has not seen a doctor in over 20 years. Her medical history is unremarkable. She takes no medications. Physical examination shows a somnolent, obese woman with dry mucous membranes. The neurological examination is nonfocal. Results of laboratory studies are as follows: sodium concentration, 128 mEq/L; potassium concentration, 4.5 mEq/L; chloride concentration, 94 mEq/L; serum glucose level, 810 mg/dl; renal function, normal. Which of the following would be the most appropriate intervention in the care of this patient?
A. Fluid restriction and loop diuretics
B. Administration of hypertonic saline
C. Administration of normal saline and insulin
D. Demeclocycline
E none
The correct answer and explanation will be available after you answer.
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#1
Re: electrolytes babbu5508 - 07-16-10 00:11 My answer is: c.
C. Administration of normal saline and insulin...the patient probably has diabetic coma...administer insulin to gradually reduce blood glucose
#4
Re: electrolytes
bingousmle - 07-17-10 02:07 My answer is: c.
the hyponatremia is actually due to the raised serum osmoles due to glucose which draws intracellular fluid out and causes dilution..
#11
Re: electrolytes mockingbird - 06-30-11 12:29 My answer is: c.
This patient has Diabetic Mellitus and Diabetic Ketoacidosis. Proven by somnolent, dry mucous membranes, serum glucouse level 810mg/dl.
#16
Re: electrolytes nitishkumar - 08-06-11 11:34 My answer is: c.
she is hyponatremic as well as hypperglycemic
#17
Re: electrolytes evelia - 08-07-11 03:00 My answer is: c.
hyperglycemia with low sodium is in the patient. giving insulin and fluids will correct the hyperglycemia. The choice of normal saline is appropriate because it will after administration of insulin the levels of sodium, potassium and chloride should normalise so an isotonic solution would be appropriate
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