50-year-old obese woman is taking oral hypoglycemic agents. While being treated for a lower respiratory infection, she develops lethargy and is brought to the emergency room with decreased level of consciousness. On examination, there is no focal neurologic findings or neck rigidity, but she is confused. Laboratory results reveal sodium 134 mEq/L, potassium 4.0 mEq/L, HCO3 25 mEq/L, Cl 103 mEq/L, glucose 900 mg/dL, BUN 84 mg/dL, and creatinine 3.0 mg/dL. Which of the following is the most likely cause of this patient's coma?
سؤال مجاني 9 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
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الإجابة: D. Hyperosmolar hyperglycemic state
An obese type 2 diabetic with an infection, glucose 900 mg/dL, normal bicarbonate (25, no acidosis; anion gap = 6) and depressed consciousness = hyperosmolar hyperglycemic state. Calculated osmolality ≈ 2(134) + 900/18 + 84/2.8 ≈ 348 mOsm/kg (>320), with prerenal azotaemia from severe dehydration.
- DKA (A) needs ketosis with acidosis (HCO₃ <15 / pH <7.3) — absent here.
- SIADH (B) would cause hyponatremia; no meningism or focal signs to suggest meningitis (C).
ليش كل خيار صح أو غلط
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A
ليش غلط
DKA needs ketonaemia and an anion-gap metabolic acidosis (HCO3 below 15 and/or pH below 7.3). Her HCO3 is 25, so there is no acidosis.
✓ Diabetes mellitus overall Copy.pdf · p. 11 -
B
ليش غلط
SIADH causes true hypotonic hyponatraemia with serum osmolality below 280; this patient has a high osmolality (about 348) because of the glucose of 900.
✓ Step_Up_To_Medicine_6th,_2024_Electrolytes_Na,K_Imbalance.pdf · p. 2 -
C
ليش غلط
Meningitis classically gives fever, meningismus (headache, neck stiffness, photophobia) and altered mental state; she has no neck rigidity or focal signs, and glucose 900 with high osmolality already explains the coma.
✓ CNS infection.pdf · p. 1 -
D
ليش صح
HHS means glucose above 600, serum osmolality above 320, severe dehydration and no ketoacidosis. Here glucose is 900, HCO3 25 and she is confused.
✓ Diabetes mellitus overall Copy.pdf · p. 12
- المصدر
- Diabetes mellitus overall Copy.pdf · p. 12
Diabetes mellitus overall Copy.pdf · p. 11 - المحاضرة
- DKA & HHS · Endocrinology · Module B
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