A 20-year-old woman is brought to the emergency department due to lethargy. According to her mother, the
patient had a “stomach bug” 4 days ago w th nausea, vomiting, and abdominal pain that began after eating in a
local restaurant. Since that time her vomiting has resolved, but the patient has had worsening symptoms and
decreased oral intake. In addition, over the last few weeks the patient has experienced a 4-kg (9-lb) weight loss
associated with excessive thirst. Medical history is unremarkable. She is not sexually active, and her last
menstrual period was 10 days ago. The patient occasionally drinks beer but does not smoke or use illicit drugs.
Temperature is 37.2 C (99 F), blood pressure is 100/56 mm Hg, pulse is 120/min (regular and weak), and
respirations are 28/min (rapid and deep). Pulse oximetry is 97% on room air. On examination, the patient is
lethargic but easily arousable, responds to questions in short sentences, and moves all of her extremities
spontaneously. Mucous membranes are dry, and the neck is supple. Other than tachycardia, cardiopulmonary
examination is normal. She has diffuse abdominal tenderness without rebound tenderness, guarding, or rigidity.
Which of the following is the most appropriate immediate next step in management of this patient s illness?
- Q A. 12-lead ECG
- 0 B. Bedside abdominal ultrasound
- 0 C. CT scan of head
- O D. Endotracheal intubation
- 0 E. Fingerstick glucose
- F. Lumbar puncture
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