A 67-Year-Old Woman Comes to the Emergency Department Because of Severe

A 67-year-old woman comes to the emergency department because of severe weakness, fatigue, and non-bloody diarrhea.  She has well-controlled diabetes mellitus type 2 and bronchial asthma.  The patient used to smoke 1 pack of cigarettes daily for 25 years but quit 10 years ago.  She does not use alcohol or illicit drugs.  Her medications include glyburide, metformin, albuterol, and fluticasone metered dose inhalers.  Her temperature is 37.8 C (100 F), blood pressure is 92/61 mm Hg, pulse is 106/min, and respirations are 32/min.  Examination shows no pulmonary or cardiac abnormalities on auscultation.  The patient's laboratory tests show the following: The patient's serum creatinine was 1.7 mg/dL 3 months ago.  Which of the following is the most appropriate immediate next step?

A)Administer intravenous (IV) insulin and fluids; order ketones and arterial blood gas (ABG)
B)Administer IV fluids and order ketones, lactate, and ABG
C)Order a chest x-ray and start antibiotics
D)Order stool analysis and start oral metronidazole
E)Start nebulized albuterol, IV corticosteroids, and oxygen therapy

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