481.A 32-year-old man is brought to the ED by EMS for confusion. EMS
reports that the patient was at a local pharmacy filing his prescriptions when
the pharmacist noticed the patient sweating and having difficulty answering
questions. In the ED, the patient’s BP is 130/68 mm Hg, HR is 120 beats per
minute, temperature is 98.9°F, and RR is 12 breaths per minute. The patient
is unable to explain what happened. His fingerstick glucose is 410 mg/dL and
his urine is positive for ketones. An electrolyte panel reveals Na+131 mEq/L,
K+4 mEq/L, Cl−91 mEq/L, and Ca2+11 mEq/L. Which of the following elec-
trolytes are most important to supplement during the management of his med-
ical condition?
a. Sodium, potassium, and calcium
b. Sodium
c. Potassium
d. Calcium
e. Sodium and calcium
482.A 36-year-old immigrant woman is brought to the ED from her work-
place. She was found to be agitated and behaving bizarrely. The patient’s past
medical history and medications are unknown. Her BP is 162/92 mm Hg,
HR is 140 beats per minute, temperature is 101.8°F, and RR is 18 breaths per
minute. On examination, the patient is delirious, tremulous, and has a large
goiter. Which of the following is the most appropriate management of this
patient?
a. Administer dantrolene.
b. Administer acetaminophen and broad coverage antibiotics.
c. Protect airway, administer iodine.
d. Administer diazepam.
e. Protect airway, administer acetaminophen, propranolol, and PTU.
483.A 75-year-old woman is brought to the ED by EMS after she had a wit-
nessed seizure on the street. A bystander reports that the patient fell to the
ground, had tonic-clonic activity, and was drooling. Her BP is 162/85 mm Hg,
HR is 95 beats per minute, temperature is 99.4°F, and RR is 16 breaths per
minute. On examination the patient is unresponsive and has a bleeding
superficial scalp laceration. Which of the following electrolyte disturbances is
least likelyto cause a seizure?
a. Hypoglycemia
b. Hyperglycemia
c. Hyponatremia
d. Hypernatremia
e. Hypokalemia
524 Emergency Medicine