An elderly patient has been having copious vomiting for several days and has become lethargic and weak. His mucous membranes are dry. He has poor skin turgor. Lab work shows: sodium of 145, ABGs: pH 7.58, PCO2 38, HCO3 38, PO2 95, SO2 98. Which response best explains the patient’s lethargy and weakness?
The hypokalemia brought on severe muscle spasms, causing exhaustion.
Due to his low potassium, his cells rely on glycolysis.
Due to the hypokalemia, his cells are hyperpolarized.
The hypernatremia caused cellular dehydration, leading to lethargy.
The Correct Answer is D
Choice A rationale
Hypokalemia can cause muscle weakness and cramps, but it does not typically lead to severe muscle spasms causing exhaustion. The patient’s symptoms of lethargy and weakness are more likely related to electrolyte imbalances and dehydration rather than muscle spasms.
Choice B rationale
While low potassium levels can affect cellular metabolism, the primary issue here is not glycolysis. The patient’s symptoms are more consistent with dehydration and electrolyte imbalances rather than a metabolic shift to glycolysis.
Choice C rationale
Hypokalemia can cause cells to become hyperpolarized, leading to muscle weakness and decreased reflexes. However, the patient’s symptoms of lethargy and weakness are more likely due to dehydration and electrolyte imbalances rather than cellular hyperpolarization.
Choice D rationale
Hypernatremia, or high sodium levels, can cause cellular dehydration, leading to symptoms such as lethargy and weakness. The patient’s lab results and clinical presentation are consistent with hypernatremia-induced cellular dehydration, which explains his symptoms.
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Correct Answer is C
Explanation
Choice A rationale
Increased thirst is a symptom of hyperglycemia, not hypoglycemia. It occurs when high blood sugar levels cause dehydration.
Choice B rationale
Increased appetite can occur in hypoglycemia but is not as specific as other symptoms like slurred speech.
Choice C rationale
Slurred speech is a common symptom of hypoglycemia, indicating that the brain is not receiving enough glucose to function properly.
Choice D rationale
Polyuria is a symptom of hyperglycemia, where excess glucose in the blood leads to increased urine production.
Correct Answer is A
Explanation
Choice A rationale
Meningococcal meningitis can present with a high fever (39°C or 102.2°F) and a rash, indicating a severe bacterial infection.
Choice B rationale
Urinary tract infections typically present with urinary symptoms, not a rash.
Choice C rationale
Gastroenteritis presents with gastrointestinal symptoms, not a rash.
Choice D rationale
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