Match each acute clinical presentation and corresponding laboratory findings with the most appropriate initial intravenous therapeutic intervention.
- A 68-year-old with small cell lung cancer who develops new-onset active seizures and has a serum sodium of 112 mEq/L.Administer 3% hypertonic saline
- A 35-year-old with three days of severe watery diarrhea presenting with tachycardia, hypotension, and a serum sodium of 130 mEq/L.Administer 0.9% normal saline
- A 70-year-old with advanced chronic kidney disease presenting with severe muscle weakness, a serum potassium of 7.4 mEq/L, and widened QRS complexes on electrocardiogram.Administer calcium gluconate
- A 29-year-old recovering from severe head trauma who develops profound polyuria, a serum sodium of 154 mEq/L, and a very low urine osmolality despite fluid restriction.Administer desmopressin
Answer
Severe symptomatic hyponatremia with seizures matches to 3% hypertonic saline. Hypovolemic hyponatremia with shock matches to 0.9% normal saline. Severe hyperkalemia with ECG changes matches to calcium gluconate. Central diabetes insipidus post-trauma matches to desmopressin.
Each specific clinical emergency requires a targeted intervention based on physiological principles: hypertonic saline reduces acute brain edema in severe hyponatremia; isotonic normal saline rapidly restores intravascular volume in shock; calcium gluconate stabilizes the cardiac resting membrane potential in hyperkalemia; and desmopressin replaces the missing ADH in central diabetes insipidus.
Step-by-Step Solution
Key Concept
Emergent management of severe electrolyte and acid-base disturbances based on clinical presentation and hemodynamic status.
Estimated Time:2m 0s