Poisoning and Overdose 239224.A 60-year-old woman with a history of diabetes is brought into the ED
by EMS workers who state that the patient was found on a bus in a lethargic
and diaphoretic. Her fingerstick glucose level at the scene was 35 mg/dL.
EMS workers quickly administered dextrose through an IV line. The patient
became alert and responsive and remained this way throughout her trip to
the ED. However, in the ED you notice that the patient is again diaphoretic
and is mumbling her speech. Her fingerstick glucose is now 47 mg/dL. You
administer dextrose and she perks right up. Which of the following diabetes
medications commonly causes hypoglycemia for which the patient is likely
to require hospital admission?
a. Regular insulin
b. Metformin
c. Glyburide
d. Rosiglitazone
e. Acarbose
225.A 23-year-old woman presents to the ED complaining of abdominal
pain, nausea, and vomiting. She has a history of depression but is not cur-
rently taking any antidepressant medications. Upon further questioning,
the patient states that she ingested a bottle of pills in her medicine cabinet
approximately 3 hours ago. Her BP is 115/65 mm Hg, HR is 101 beats per
minute, temperature is 100.1°F, RR is 29 breaths per minute, and oxygen
saturation is 100% on room air. Physical examination is unremarkable
except for mild diffuse abdominal tenderness. Laboratory results reveal a
white blood cell (WBC) count of 10,300/μL, hematocrit 46%, platelets
275/μL, aspartate transaminase (AST) 70 U/L, alanine transaminase (ALT)
85 U/L, alkaline phosphatase 75 U/L, sodium 143 mEq/L, potassium
3.7 mEq/L,chloride 98 mEq/L, bicarbonate 8 mEq/L, blood urea nitrogen
(BUN) 22 mg/dL, creatinine 0.9 mg/dL, and glucose 85 mg/dL. Arterial blood
gas values on room air are pH 7.51, PCO 2 11 mm Hg, and PO 2 134 mm Hg.
Which of the following substances did this patient most likely ingest?
a. Diphenhydramine (Benadryl)
b. Ibuprofen
c. Acetaminophen
d. Aspirin
e. Pseudoephedrine