A 31-year-old white male patient with known type 1 diabetes mellitus, end-stage renal disease secondary to dial nephropathy, and a history of alcoholism was admitted with acute abdominal pain in the mid-epigastrium, with a b gas values of pH of 7.48, po2 of 121 mm Hg, O2 saturation of 99%, PCO2 of 30 mm Hg, and bicarbonate of 20 mE What is a possible compensatory mechanism? A. Decreasing H ion retention B. Increasing bicarbonate retention c. Increasing the respiratory rate D. Decreasing the respiratory rate
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- A 49-year-old male was brought to the Emergency Department for evaluation of nausea, fatigue, and weakness for 24 h. His wife says that he had been having binge drinking without any food intake. He is not taking any medications. On physical examination, he was euvolemic. His weight is 70 kg. BP is 100/60 mmHg with a pulse rate of 82 beats/min. Serum [Na] is 120 mEq/L; [K] 3.8 mEq/L; BUN 8 mg/dL; creatinine 0.6 mg/dL; and osmolality 230 mOsm/kg H,O. Urine studies are: Osmolality 75 mOsm/kg H,O; Na* 10 mEq/L; and K* 20 mEq/L. The diagnosis of beer potomania was made. Assuming no urine output in 2-3 h, which one of the following is the MOST appropriate therapy for this patient? A. D5W B. 0.9 % NaCI C. 3% NaCl D. 0.45 % NaCl E. Fluid restriction and NaCl tabletsPatient M, 72 y/o, is in the intensive care unit with the symptoms of dehydration, oliguria, hypothermia, hypoxemia (hypoxia). In the anamnesis there is a record of type 2 diabetes mellitus treated with biguanides. Her condition began to deteriorate after she had a myocardial infarction one month ago. Objectively: the skin is dry; turgor is lowered, arterial pressure – 80/40 mm column of mercury, pulse – 136beats/minute. The breathing is shallow, eye ball tone is lowered. What is your diagnosis?A. Hyperlactacidemic comaB. Uremic comaC. Ketoacidotic comaD. Brain comaE. Hyperosmolar comaPatient A is 65 years old female. She has been diagnosed with diabetes Type II. Recently she experienced a gastrointestinal illness with nausea and vomiting. Lab data have been obtained the following day after her illness: Body weight 85 kg; Blood pressure 140/90 mmHg; Blood pH – 7.48; PCO2 – 44 mm Hg; Plasma HCO3 ion -32 mEq/L; Urine pH – 7.5. What is acid-base disorder of this patient. What was a main cause of this? The illness continues and after 2 days the following laboratory data have been obtained: Body weight 83 kg; Blood pressure 120/70 mmHg; Blood pH – 7.50; PCO2 – 48 mm Hg; Plasma HCO3 ion -36 mEq/L; Urine pH – 6.0. Has acid-base disbalance been changed? If yes, what is the explanation for this acid-base disbalance? Is there any compensation?
- Pt is a 55 y.o female with past medical history of end-stage renal disease on hemodialysis via perm catheter, hypertension, hyperlipidemia, type 2 diabetes, anemia of chronic disease, peripheral neuropathy, recurrent C.Difficile. History of Acinetobacter bacteremia come into the hospital as direct transfer from Newport given worsening pleural effusion of importance. Pt was recently admitted at Rhode Island Hospital and discharged a few weeks ago after being diagnosed with necrotizing pneumonia. lung disease abscess on CT scan. She underwent BAL and culture grew klebsiella oxytocin which she was treated with Augmentin for 6weeks duration. She had elevated 1,3 Beta D flu an but was deemed to be potentially false positive. She was also found to have Acinetobacter growing from dialysis catheter too and the catheter was removed on 3/8 and a new one was replaced on 3/9. Unfortunately came back from Newport hospital because of progressively worsening shortness of breath as well as well as…Pt is a 55 y.o female with past medical history of end-stage renal disease on hemodialysis via perm catheter, hypertension, hyperlipidemia, type 2 diabetes, anemia of chronic disease, peripheral neuropathy, recurrent C.Difficile. History of Acinetobacter bacteremia come into the hospital as direct transfer from Newport given worsening pleural effusion of importance. Pt was recently admitted at Rhode Island Hospital and discharged a few weeks ago after being diagnosed with necrotizing pneumonia. lung disease abscess on CT scan. She underwent BAL and culture grew klebsiella oxytocin which she was treated with Augmentin for 6weeks duration. She had elevated 1,3 Beta D flu an but was deemed to be potentially false positive. She was also found to have Acinetobacter growing from dialysis catheter too and the catheter was removed on 3/8 and a new one was replaced on 3/9. Unfortunately came back from Newport hospital because of progressively worsening shortness of breath as well as well as…Pt is a 55 y.o female with past medical history of end-stage renal disease on hemodialysis via perm catheter, hypertension, hyperlipidemia, type 2 diabetes, anemia of chronic disease, peripheral neuropathy, recurrent C.Difficile. History of Acinetobacter bacteremia come into the hospital as direct transfer from Newport given worsening pleural effusion of importance. Pt was recently admitted at Rhode Island Hospital and discharged a few weeks ago after being diagnosed with necrotizing pneumonia. lung disease abscess on CT scan. She underwent BAL and culture grew klebsiella oxytocin which she was treated with Augmentin for 6weeks duration. She had elevated 1,3 Beta D flu an but was deemed to be potentially false positive. She was also found to have Acinetobacter growing from dialysis catheter too and the catheter was removed on 3/8 and a new one was replaced on 3/9. Unfortunately came back from Newport hospital because of progressively worsening shortness of breath as well as well as…
- Patient WY 58 y/o weighs 130 lbs is diagnosed with pneumonia. Her physician requested for serum creatinine test and the result is 8.5mg/dL. Because of her current condition, her attending physician prescribed Amoxicillin 500mg PO Q12. Is the order correct based on the renal function of the patient? If incorrect, what is your recommended regimen? CrCl 10 to 30 mL/min: 250 to 500 mg orally every 12 hours CrCl 9 mL/min or less: 250 to 500 mg orally every 24 hours The 875 mg tablets and the 775 mg extended-release tablets should not be given to patients with CrCl less than 30 mL/minAn 80-year old woman was admitted for nausea, headache, and psychosis for 2 days: Past medical history includes hypertension, and her physician increased hydrochlorothiazide (HCTZ), from 12.5 to 25 mg daily. The patient was drinking water more than usual. Her BP was 120/70 mmHg and pulse rate of 80 beats/min. There were no orthostatic BP and pulse changes. Serum chemistry: Na* 112 mEq/L, K* 3.2 mEq/L, CI- 90 mEq/L, and glucose 90 mg/dL. The urine osmolality is 220 mOsm/kg H,O. She weighs 70 kg. Which one of the following statements regarding her hyponatremia is CORRECT? A. Furosemide rather than HCTZ is a frequent cause of hyponatremia. B. HCTZ impairs urine concentrating capacity C. Electrolyte-free H,O clearance decreases with HCTZ D. Electrolyte-free H,O clearance increases with HCTZ E. None of the aboveIn this case, a 72-year-old man with a medical history that includes hypertension, type 2 diabetes, coronary artery disease with stent implantation, and congestive heart failure is hospitalized for dyspnea while at rest. Despite salt restriction and diuretics, he continued to have swelling in his legs for four weeks. His L ejection fraction (EF) is 40 percent, which is excellent. Humalog (75/25) 20 units QD, furosemide 40 mg BID, metolazone 2.5 mg QD, spironolactone 12.5 mg QD, carvedilol 12.5 mg BID, ramipril 10 mg QD, atorvastatin 40 mg QD, clopidogrel 75 mg QD, and aspirin 81 mg QD are among the medications prescribed. The patient's blood pressure was 100/60 mmHg, his pulse was 102 beats/min, he had JVD, crackles, an S3, a positive hepatojugular reflex, and pitting edema that reached his knees. Na+ concentrations were 134 mEq/L, K+ concentrations were 3.8 mEq/L, Cl concentrations were 90 mEq/L, HCO3 concentrations were 28 mEq/L, BUN concentrations were 46 mg/dL, creatinine…
- A 68-year-old patient was delivered to the intensive care unit with the suspicion of hyperlactacidemic coma and complaints of severe muscle ache, vomiting drowsiness alternating with stupor, pain in the heart region. Objectively: eye ball tone is lowered, arterial pressure –100/55, pulse - 136beats/minute, glycemia - 14mmol/l, acidosis, blood PH – 7.0, level of lactic acid – 1.9mmol/l. What are you going to do in this case?A. Injecting 1% solution of methylene blueB. Injecting 500ml 5% glucose solutionC. Injecting 0.1% adrenaline solutionD. Introducing 100 mg prednisoloneE. Introducing 500 ml 0.9% sodium chlorideA 45-year-old man is being treated with oral levofloxacin for urinary tract infection. The plasma clearance of the drug is calculated as 15.0 L/h. Oral bioavailability of the drug is 75%. Sensitivity analysis of a sputum culture shows a minimal inhibitory concentration of 1 µg/mL for the causative pathogen. The target plasma concentration is 2 mg/L. If the drug is administered twice per day. Which of the following dosages should be administered at each dosing interval to maintain a steady state? (A)300 mg (B) 480 mg (C) 520 mg (D) 600 mg (E) 710 mgThe doctor orders ciprofloxacin 200 mg IVPB q.12h . The pharmacy sent the following premixed IVPB of ciprofloxacin . The drug reference states that IV ciprofloxacinis to be administered over 60 min . What rate will the nurse set on the IV pump (mL / h r)?
