Título Em Endocrinologia E Metabologia Practice Questions - TEEM - Título De Especialista Em Endocrinologia E Metabologia (SBEM AMB) Exam

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A 74-year-old male is brought to the emergency department with profound lethargy, severe dehydration, and obtundation. Laboratory evaluation reveals: plasma glucose 940 mg/dL, serum sodium 152 mEq/L, potassium 4.8 mEq/L, bicarbonate 20 mEq/L, arterial pH 7.36, serum creatinine 2.4 mg/dL (baseline 1.0 mg/dL), and calculated effective serum osmolality 342 mOsm/kg. Urine dipstick shows trace ketones. A diagnosis of Hyperosmolar Hyperglycemic State (Estado Hiperosmolar Hiperglicêmico - EHH) is established. What is the initial priority in the resuscitation of this patient?

Immediate intravenous bolus of regular insulin at 0.4 units/kg before any fluid administration. Intravenous infusion of sodium bicarbonate to correct mild metabolic acidosis. Aggressive fluid resuscitation with isotonic 0.9% NaCl (1,000–1,500 mL in the first hour) to restore intravascular volume, followed by reassessment of corrected sodium. Initiation of intravenous potassium chloride bolus without fluids because total body potassium is severely depleted.

Correct Answer:

Aggressive fluid resuscitation with isotonic 0.9% NaCl (1,000–1,500 mL in the first hour) to restore intravascular volume, followed by reassessment of corrected sodium.

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