Step 2

Endocrine 1

A 33-year-old woman presents to the emergency department with rapid onset confusion, severe abdominal pain and vomiting over the last 1 hour. A collateral history from her partner reveals that she has been having unusual salt cravings and light-headedness upon standing over the past 2 months, but had put this down to her recent increased stress from work. Past medical history is significant for Graves’ disease, which is well-controlled on carbimazole. Vital signs are temperature 38.0° C (100.4° F), blood pressure 80/59 mmHg, pulse 92 beats/min, and respirations 18/min. On physical examination, the patient has a capillary refill time of 4 seconds and dry mucous membranes. A generalized bronze skin tan is also noted. Pertinent laboratory studies include the following:

  • Sodium - 128 mmol/L
  • Potassium - 6.0 mmol/L
  • Glucose - 3.1 mmol/L

Intravenous access is obtained, and the patient is transferred to intensive care unit (ICU).

Which of the following is the definitive therapy for this patient?

  • A) Intravenous 0.9% sodium chloride
  • B) Intravenous 5% dextrose
  • C) Intravenous hydrocortisone
  • D) Intravenous insulin
  • E) Intravenous norepinephrine

Authors

Geraldine Le

Editor

Dr. Ted O'Connell

Last updated

Jun 02, 2022

Our Other Products: