A 60-year-old man with type II diabetes mellitus requires emergency incision and drainage of a perirectal abscess. Laboratory studies show a serum glucose concentration of 850 mg/dl and a pHa of 7.30. The most appropriate management is administration of regular insulin and which of the following infusions?
(A) 5% Dextrose in water
(B) 5% Dextrose in 0.45% saline solution with potassium chloride
(C) 5% Dextrose in 0.45% saline solution with potassium chloride and mannitol
(D) Normal saline solution
(E) Normal saline solution and sodium bicarbonate
D
A 65-year-old man with essential hypertension well controlled around 140/90 mmHg with hydrochlorothiazide is scheduled for right colectomy for carcinoma. Preoperative EKG and all laboratory values are normal except for a hematocrit of 29% and serum potassium level of 3.2 mEq/L. Central venous pressure (CVP) measured from an internal jugular catheter inserted before induction of anesthesia is 7 mmHg. Ten minutes after induction with thiopental 200 mg followed by enflurane 3% in nitrous oxide and oxygen (50% each), blood pressure decreases suddenly from 110/70 to 80/50 mmHg with heart rate unchanged at 78 bpm. CVP is now 20 mmHg and the EKG demonstrates a midjunctional rhythm. After discontinuing the enflurane, the most appropriate action would be to
(A) administer furosemide 20 mg intravenously
(B) verify proper placement of the CVP catheter
(C) administer atropine 0.4 mg intravenously
(D) administer packed erythrocytes 1 unit
(E) administer potassium 20 mEq in 250 ml of intravenous fluid over 15 minutes
A 26-year-old patient with multiple trauma is admitted to the intensive care unit postoperatively. The early development of polyuria, hypotension, low urine sodium excretion, high serum osmolality, and normal serum creatinine concentration is best explained by