A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition?

Choice A reason: Weight loss is a common clinical manifestation of type 1 diabetes mellitus in children. Type 1 diabetes mellitus is a condition where the pancreas does not produce enough insulin, a hormone that helps the cells use glucose for energy. Without insulin, the glucose stays in the blood and causes high blood sugar levels. The body then breaks down fat and muscle for energy, resulting in weight loss.

Choice B reason: Low urine output is not a typical clinical manifestation of type 1 diabetes mellitus in children. In fact, the opposite is true: high urine output is a sign of type 1 diabetes mellitus. This is because the excess glucose in the blood draws water from the cells and tissues, causing dehydration and increased thirst. The kidneys then try to flush out the glucose and water through urine, leading to frequent urination.

Choice C reason: Weight gain is not a usual clinical manifestation of type 1 diabetes mellitus in children. As explained in choice A, type 1 diabetes mellitus causes weight loss due to the lack of insulin and the breakdown of fat and muscle. Weight gain can be a sign of type 2 diabetes mellitus, which is a condition where the cells become resistant to insulin and the pancreas cannot produce enough insulin to overcome the resistance. Weight gain can also be a side effect of insulin therapy, which is used to treat both types of diabetes mellitus.

Choice D reason: Hand tremors are not a specific clinical manifestation of type 1 diabetes mellitus in children. Hand tremors can be caused by many factors, such as anxiety, stress, caffeine, medication, or neurological disorders. Hand tremors can also be a symptom of hypoglycemia, which is a condition of low blood sugar that can occur in people with diabetes mellitus. However, hypoglycemia is not exclusive to diabetes mellitus, and can affect anyone who has a low intake of food, a high expenditure of energy, or a high dose of insulin or oral hypoglycemic agents.

Choice A reason: 363 is not the correct answer. This is the daily maintenance fluid requirement for an infant who weighs 3.5 kg, not 16 kg. The formula for calculating the daily maintenance fluid requirement for infants who weigh between 3.5 and 10 kg is 100 mL/kg¹.

Choice B reason: 727 is not the correct answer. This is the daily maintenance fluid requirement for an infant who weighs 10 kg, not 16 kg. The formula for calculating the daily maintenance fluid requirement for infants who weigh between 10 and 20 kg is 1000 mL plus 50 mL for every kg over 10¹.

Choice C reason: 1300 is the correct answer. This is the daily maintenance fluid requirement for an infant who weighs 16 kg. The formula for calculating the daily maintenance fluid requirement for infants who weigh between 10 and 20 kg is 1000 mL plus 50 mL for every kg over 10¹. Therefore, for an infant who weighs 16 kg, the daily maintenance fluid requirement is 1000 mL plus 50 mL times 6, which equals 1300 mL.

Choice D reason: 1600 is not the correct answer. This is the daily maintenance fluid requirement for an infant who weighs 20 kg, not 16 kg. The formula for calculating the daily maintenance fluid requirement for infants who weigh between 10 and 20 kg is 1000 mL plus 50 mL for every kg over 10¹. For infants who weigh more than 20 kg, the formula is 1500 mL plus 20 mL for every kg over 20¹.