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A 15-Year-Old Girl Is Brought to the Office After Falling

Question 854
Multiple Choice
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Multiple Choice

A 15-year-old girl is brought to the office after falling in the shower.  Her mother was outside of the bathroom when she heard a thud, and went in and found her daughter trying to get back up.  The patient insists, "I just slipped.  It's no big deal.  I am fine."  She reports that she had no loss of consciousness, tongue biting, incontinence, or confusion.  Her parents are concerned that she lost her balance because she is thin and eats poorly.  They also note that she seems depressed and has not been interested in seeing any friends.  The patient admits, "I have been a little down since my boyfriend broke up with me, but I don't blame him because I am so fat."  She takes no medications, has no allergies, and does not use tobacco, alcohol, or illicit drugs.  Temperature is 35.6 C (96 F), blood pressure is 100/60 mm Hg sitting and 80/48 mm Hg standing, pulse is 50/min, and respirations are 14/min.  BMI is 16 kg/m2.  Examination shows an alert and cooperative girl with dry mucous membranes and emaciation.  Calluses are present over the knuckles.  The abdomen is soft, nontender, and nondistended.  Urine hCG is negative.  Laboratory results are as follows:
img The patient is admitted to the hospital.  Thiamine is administered prior to initiation of a supervised diet.  On the third day of hospitalization, the patient develops progressive dyspnea and orthopnea.  Temperature is 35.6 C (96 F), blood pressure is 100/60 mm Hg sitting and standing, pulse is 78/min, and respirations are 24/min.  Examination reveals an anxious girl with bibasilar crackles, dullness to percussion of the lung bases, and pretibial pitting edema.  Laboratory results are as follows:
img Which of the following therapies should be administered immediately?

A)Intravenous dextrose
B)Intravenous digoxin
C)Intravenous normal saline bolus
D)Oral furosemide
E)Oral phosphate

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