A 21-year-old female university student is brought to the emergency department by her roommate due to generalized weakness, muscle cramps, and a syncopal episode earlier that morning. The roommate mentions that the patient is under immense stress due to impending final exams. For the past year, the patient has drastically restricted her food intake during the day, but at night, she frequently consumes unusually large quantities of high-calorie foods, followed by prolonged periods in the bathroom with the water running. The patient recently visited the campus clinic for low mood and to get help quitting smoking; she was prescribed a new medication that she began taking two days ago.
Physical examination reveals a frail-appearing woman. Her BMI is 17.1 kg/m². Vital signs show a temperature of 36.3°C (97.3°F), blood pressure of 90/56 mm Hg, heart rate of 112/min while supine that increases to 138/min upon standing, and respiratory rate of 10/min. She has bilateral parotid gland enlargement, poor dentition with enamel erosion, and fine, downy hair over her back.
| Laboratory Test | Result | Reference Range |
|---|---|---|
| Sodium | 136 mEq/L | 136-145 mEq/L |
| Potassium | 2.6 mEq/L | 3.5-5.0 mEq/L |
| Chloride | 84 mEq/L | 95-105 mEq/L |
| Bicarbonate | 36 mEq/L | 22-28 mEq/L |
| Magnesium | 1.2 mg/dL | 1.7-2.2 mg/dL |
| Parameter | Result | Reference Range |
|---|---|---|
| pH | 7.51 | 7.35-7.45 |
| pCO2 | 56 mm Hg | 35-45 mm Hg |
| pO2 | 92 mm Hg | 75-105 mm Hg |
Based on the clinical and laboratory findings, which of the following is the most accurate statement regarding this patient's condition and management?
- The newly started medication for smoking cessation is strictly contraindicated in this patient as it drastically lowers the seizure threshold.Cevap
- BThe arterial blood gas parameters demonstrate a fully compensated primary metabolic alkalosis.
- CInitiation of fluoxetine is the most effective evidence-based pharmacologic therapy for her primary psychiatric condition.
- DFollowing oral electrolyte supplementation in the emergency department, she can be safely discharged to an intensive outpatient program.
- EImmediate initiation of high-carbohydrate enteral nutrition is the priority to reverse her starvation state and prevent cardiac arrhythmias.