ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 2 — Questions and Answers
Question 1: A patient presents with oliguria, BUN 80, creatinine 6.2 (baseline 1.0), and no urine output for 12 hours. Bladder scan shows 600 mL. What is the next step?
- Start hemodialysis
- Foley catheter placement (Correct answer)
- IV furosemide
- Nephrology consult first
Correct answer: Foley catheter placement
Post-renal AKI from bladder outlet obstruction requires immediate Foley catheterization to relieve the obstruction.
Question 2: A patient with diabetes presents with nausea, vomiting, blood glucose 520 mg/dL, pH 7.20, bicarbonate 10, and ketones positive. What is the most critical initial intervention?
- Insulin infusion immediately
- IV fluid resuscitation with normal saline (Correct answer)
- Sodium bicarbonate infusion
- Dextrose 50% IV
Correct answer: IV fluid resuscitation with normal saline
IV fluid resuscitation is the most critical first step in DKA to restore intravascular volume before initiating insulin therapy.
Question 3: A patient on ACE inhibitor presents with serum potassium of 6.8 mEq/L and peaked T-waves on ECG. What is the FIRST treatment to administer?
- Sodium bicarbonate IV
- Calcium gluconate IV (Correct answer)
- Insulin plus dextrose
- Kayexalate
Correct answer: Calcium gluconate IV
Calcium gluconate is the first-line treatment in hyperkalemia with ECG changes because it stabilizes the cardiac membrane immediately.
Question 4: A patient presents with confusion, serum sodium of 118 mEq/L, and euvolemia. What is the safest correction rate for chronic hyponatremia?
- Correct as fast as possible
- No more than 8–10 mEq/L in 24 hours (Correct answer)
- Correct to 130 within 4 hours
- Give 3% saline at rapid rate
Correct answer: No more than 8–10 mEq/L in 24 hours
Overcorrecting chronic hyponatremia faster than 8–10 mEq/L per 24 hours risks osmotic demyelination syndrome (central pontine myelinolysis).
Question 5: A patient with a history of kidney stones presents with colicky flank pain radiating to the groin, hematuria, and nausea. CT shows a 7 mm ureteral stone. What is the appropriate management?
- Immediate urologic intervention
- Pain control, hydration, alpha-blocker, and urology follow-up (Correct answer)
- Extracorporeal shock wave lithotripsy in ED
- Foley catheter and observation
Correct answer: Pain control, hydration, alpha-blocker, and urology follow-up
Stones 5–10 mm have a moderate chance of spontaneous passage; alpha-blockers (e.g., tamsulosin) plus analgesia and urology follow-up is appropriate.
Question 6: A patient presents with altered mental status, tachycardia, fever, and a thyroid-stimulating hormone near zero with T4 markedly elevated. What is the diagnosis?
- Myxedema coma
- Thyroid storm (Correct answer)
- Sick euthyroid syndrome
- Subacute thyroiditis
Correct answer: Thyroid storm
Thyroid storm is a life-threatening hypermetabolic emergency characterized by hyperthermia, tachycardia, altered mental status, and extremely low TSH.
ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 2
A patient presents with oliguria, BUN 80, creatinine 6.2 (baseline 1.0), and no urine output for 12 hours.
Bladder scan shows 600 mL.
What is the next step?