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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