Altered Mental Status 271256.A 45-year-old man is brought to the ED by his coworkers after col-
lapsing to the floor while at work. A coworker states that the patient mis-
takenly took several tablets of his oral diabetic medications a few hours
ago. The patient is unresponsive and diaphoretic. His BP is 142/78 mm Hg,
HR is 115 beats per minute, temperature is 98.9°F, and RR is 12 breaths per
minute. A bedside glucose reads 42 mg/dL. Which of the following is the
most appropriate management of this patient?
a. Administer IV dextrose, obtain a repeat fingerstick glucose every hour and if
normal after 6 hours discharge the patient home.
b. Administer IV dextrose and continue monitoring his blood sugar for at least
24 hours.
c. Administer IV fluids and insulin.
d. Administer IV fluids.
e. Administer activated charcoal and IV fluids.
257.A 59-year-old man is brought into the ED accompanied by his son
who states that his father is acting irritable and occasionally confused. The
son states that his father has a history of hepatitis from a transfusion he
received many years ago. Over the past 5 years, his liver function slowly
deteriorated. His vital signs include BP of 145/80 mm Hg, a HR of 78 beats
per minute, RR of 16 breaths per minute, oxygen saturation of 98%, and
temperature of 98°F. Laboratory results are all within normal limits, except
for an ammonia level that is significantly elevated. Which of the following
is the best therapy?
a. Vancomycin and gentamycin
b. Lactulose and neomycin
c. Ampicillin and gentamycin
d. Levofloxacin
e. Ciprofloxacin