ABEM Gastrointestinal, Renal & Metabolic Emergencies Flashcards

A patient presents with a serum glucose of 40 mg/dL and confusion. The patient is unable to swallow safely. What is the correct treatment?

Answer: Dextrose 50% (D50) IV push

IV D50 is the fastest and most reliable treatment for symptomatic hypoglycemia when the patient cannot safely swallow.

A patient taking metformin presents with lactic acidosis, pH 7.05, lactate 12, and acute renal failure. What is the most effective treatment?

Answer: Hemodialysis

Hemodialysis is the definitive treatment for severe metformin-associated lactic acidosis as it removes metformin and corrects acidosis.

A patient with end-stage renal disease on dialysis presents with shortness of breath, JVD, crackles, and BP 200/110. What is the most appropriate ED treatment?

Answer: Nitroglycerin and emergent dialysis

ESRD patients are anuric and unresponsive to diuretics; nitroglycerin for afterload reduction and emergent dialysis is definitive treatment for flash pulmonary edema.

A patient presents with severe epigastric pain, fever, and jaundice. RUQ ultrasound shows CBD dilation and stones. What is the diagnosis?

Answer: Ascending cholangitis (Charcot's triad)

Charcot's triad (fever, jaundice, RUQ pain) represents ascending cholangitis — a surgical emergency requiring antibiotics and biliary decompression.

A patient with known Addison's disease presents with hypotension, weakness, and hyponatremia with hyperkalemia. What is the immediate treatment?

Answer: IV hydrocortisone and normal saline

Adrenal crisis requires immediate IV hydrocortisone (stress-dose) and aggressive IV normal saline to restore volume and cortisol deficiency.

A patient presents with calcium of 14.2 mg/dL, confusion, polyuria, and constipation. What is the first-line treatment for hypercalcemic crisis?

Answer: IV normal saline hydration

Aggressive IV normal saline rehydration is the cornerstone first step in treating hypercalcemic crisis, increasing renal calcium excretion.