08-10-2017, 12:05 PM
An 81 -year-old woman, who was admitted to the hospital 8 hours ago from the emergency
department for evaluation of severe chest pain, suddenly has cardiac arrest. She had been treated
with aspirin, and intravenous nitroglycerin, furosemide, and metoprolol in the emergency
department after an ECG showed anterior cardiac ischemia. Cardiopulmonary resuscitation is
now initiated and the patient is intubated; after 30 minutes her pulse is regained and her blood
pressure stabilizes. She remains unresponsive but hemodynamically stable during the next 3
days. Medical history is remarkable for colon cancer resection 2 months ago, coronary artery
disease, and hypertension. Vital signs now are temperature 37.6°C (99.6°F), pulse 70/min,
respirations 12/min, and blood pressure 112/60 mm Hg. Auscultation of the lungs discloses
crackles at the lung bases bilaterally. Cardiac examination discloses a normal S1 and S2 and a
grade 2/6 systolic murmur heard loudest at the right upper sternal border. There is no peripheral
edema. Results of electrolyte studies and fluid status since the patient's cardiac arrest are shown:
Fluid Status
Serum Na+ (mEq/L) Intake (L) Output (L)
Day 1 140 3.5 2.6
Day 2 144 2.0 4.0
Day 3 (today) 148 2.5 5.0
Serum glucose concentration today is 160 mg/dL. Which of the following is the most likely
explanation for this patient's increased urine output?
A) Acute renal failure
B) Adverse effect of metoprolol
C) Brain injury
D) Hyperglycemia
E) Metastatic cancer
department for evaluation of severe chest pain, suddenly has cardiac arrest. She had been treated
with aspirin, and intravenous nitroglycerin, furosemide, and metoprolol in the emergency
department after an ECG showed anterior cardiac ischemia. Cardiopulmonary resuscitation is
now initiated and the patient is intubated; after 30 minutes her pulse is regained and her blood
pressure stabilizes. She remains unresponsive but hemodynamically stable during the next 3
days. Medical history is remarkable for colon cancer resection 2 months ago, coronary artery
disease, and hypertension. Vital signs now are temperature 37.6°C (99.6°F), pulse 70/min,
respirations 12/min, and blood pressure 112/60 mm Hg. Auscultation of the lungs discloses
crackles at the lung bases bilaterally. Cardiac examination discloses a normal S1 and S2 and a
grade 2/6 systolic murmur heard loudest at the right upper sternal border. There is no peripheral
edema. Results of electrolyte studies and fluid status since the patient's cardiac arrest are shown:
Fluid Status
Serum Na+ (mEq/L) Intake (L) Output (L)
Day 1 140 3.5 2.6
Day 2 144 2.0 4.0
Day 3 (today) 148 2.5 5.0
Serum glucose concentration today is 160 mg/dL. Which of the following is the most likely
explanation for this patient's increased urine output?
A) Acute renal failure
B) Adverse effect of metoprolol
C) Brain injury
D) Hyperglycemia
E) Metastatic cancer