Which of the fol lowing statements about the patient's condition and management is inaccurate?

A 56-year-old male is brought to your department because of altered mental status. He was being

treated for pneumonia as an outpatient. Past medical history is significant for diabetes mellitus type 2

managed with metformin and glymepiride. Vital signs are BP 110/65 mmHg, pulse 110 bpm, respiratory rate 23/min, and temperature 38.5°C. On examination the patient appears confused. His H bA 1 c was 8.2% about 2 months ago. Init ial labs reveal:

Hematocrit : 40%

Blood glucose: 45 mmol/1

Sodium: 149 mmol/1

Chloride: 109 mmol/1

Potassium: 4. 6 mmol/1

Bicarbonate: 19 mmol/1

BUN: 15.4 mmol/1

Creatinine: 142 micromol/1

Pa02: 65 mmHg

PaC02: 46 mmHg

pH: 7.33

Which of the fol lowing statements about the patient’s condition and management is inaccurate?

  • a. Myocardial infarction should be suspected and an ECG done to rule it out
  • b. Corrected serum sodium should be calculated and about 9L of sa line solution given in next 48 hours
  • c. Metformin treatment may be contributory to the patient’s condition and should be discontinued
  • d. The patient’s urine is likely to show ketone bodies and intramuscular insulin should be given for treatment
  • e. 2L ot 0.9% NaCI should be infused in the first hour as patient is likely to be severely ~lilted

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