10-22-2010, 05:42 AM
A 35-year-old man with a history of Addison's disease presents to the emergency department complaining of nausea, vomiting, and generally not feeling well for a week. He began having a cough with brownish sputum and felt feverish, with chills starting about a week ago. Yesterday, the patient began having increasing weakness, abdominal pain, and diarrhea. His wife also adds that at times he gets confused and doesn't realize where he is. His only medication is hydrocortisone 15 mg daily. His temperature is 102.7 F, with a heart rate of 116/min, a blood pressure of 89/53 mm Hg, and a respiratory rate of 25/min. He has dry mucous membranes, and bronchial sounds are heard over the right lung. The abdomen is diffusely tender to palpation, and there is no rebound tenderness. His white cell count is 18,200/mm3, sodium 126 mEq/L, potassium 5.6 mEq/L, bicarbonate 24 mEq/L, BUN 32 mg/dL, creatinine 1.1 mg/dL, and glucose 72 mg/L. The chest x-ray shows a right middle-lobe infiltrate.
What is the most urgent initial step in the management of this patient
a. 0.9% NaCl
b. 500mg erythromycin t.i.d
c. 100 mg Hydrocortisone iv
d. Potassium chloride
e. Calcium gluconate
f. Levofloxacin
What is the most urgent initial step in the management of this patient
a. 0.9% NaCl
b. 500mg erythromycin t.i.d
c. 100 mg Hydrocortisone iv
d. Potassium chloride
e. Calcium gluconate
f. Levofloxacin