Question 1

1.    Your patient is a 64 year old that presents with shortness of breath, nausea and vomiting.  Initial vital signs and labs are as follows:  HR 111, BP 102/75, Sat-98% on RA.  WBC 12.9, Hgb 12.5. Hct 36.5, Platelets 230,000.  Na-124, K-3.3, CO2-16, Glucose 394, BUN-30 Creatine 1.1.  ABG- pH-7.1, PaCO2-24, HCO3 16, PaO-96 on Room Air. Based upon this clinical data, which on the following represents the best management plan.

A.   Order 3 amps of Bicarb to correct the patients acidosis and give the patient Zofran 4 mg IV.

B.   Give the patient 2 liters of normal saline, 4 units of Zofran, and place the patient on an insulin drip.

C.  Start the patient on hypertonic saline, patients with low Na for prolonged periods of time can cause seizures

D.  Gently hydrate the patient at NS 50 mL/Hr, order 4 mg of Zofran, give 10 units of insulin subcutaneously, and admit the patient to the hospital.