Your patient is a 32-year-old female who is alert and sitting at her kitchen table complaining of dizziness and near-syncope with exertion. She describes a four-day history of a 104°F fever, nausea, vomiting, and diarrhea unrelieved with over-the-counter medications. Physical examination reveals dry skin and mucous membranes, lung sounds clear and equal bilaterally. HR = 131 and regular, BP = 84/60, RR = 20 and regular, SaO₂ = 98%, blood glucose = 58 mg/dL. She has a history of colitis, for which she often takes prednisone, but she has been noncompliant with her prednisone therapy for the past five days because she cannot afford to refill her prescription. The treatment for this patient should include:

Question

Quizplus · Accepted Answer

Given the patient's symptoms of dizziness, near-syncope with exertion, a history of fever, nausea, vomiting, diarrhea, and the physical findings of dry skin and mucous membranes, the patient is likely suffering from dehydration and hypoglycemia. The heart rate is elevated, and blood pressure is low, indicating a state of hypovolemia. The blood glucose level is also low. Therefore, a one-liter normal saline (NS) bolus will help to address the dehydration and hypovolemia, and 25 g of dextrose IV will correct the hypoglycemia. Thiamine is not specifically indicated in this scenario, and there's no immediate indication for high-flow oxygen as the patient's oxygen saturation is 98%.

Your Patient Is a 32-Year-Old Female Who Is Alert and Sitting