A 45-year-old male patient presents to the emergency department with excessive thirst, frequent urination, and signs of dehydration. His laboratory results show low urine osmolality and high serum sodium levels. Based on this case scenario, which of the following management strategies would be appropriate for this patient? (Select All that Apply.)

Choice A Reason:

Encouraging a high-sodium diet is essential for patients with Addison’s disease because they often suffer from hyponatremia (low sodium levels) due to the lack of aldosterone, a hormone that helps regulate sodium and potassium balance. Increasing sodium intake helps to counteract this deficiency and maintain proper electrolyte balance.

Choice B Reason:

Administering potassium supplements is not recommended for patients with Addison’s disease because they already have hyperkalemia (high potassium levels) due to the lack of aldosterone. Adding more potassium could exacerbate this condition and lead to serious complications such as cardiac arrhythmias.

Choice C Reason:

Administering intravenous corticosteroids is a critical intervention for managing Addison’s disease, especially during an adrenal crisis. Corticosteroids like hydrocortisone help replace the deficient hormones and stabilize the patient’s condition by reducing inflammation and supporting metabolic functions.

Choice D Reason:

Monitoring blood glucose levels regularly is important because patients with Addison’s disease can experience hypoglycemia (low blood sugar levels) due to cortisol deficiency. Regular monitoring helps in timely detection and management of hypoglycemia, preventing potential complications.

Choice E Reason:

Administering diuretics is not appropriate for patients with Addison’s disease as it can lead to further electrolyte imbalances, particularly worsening hyponatremia and hyperkalemia. Diuretics increase the excretion of sodium and potassium, which is counterproductive in managing Addison’s disease.

Choice A Reason:

Febrile non-hemolytic transfusion reactions (FNHTRs) are common and typically present with fever, chills, and sometimes rigors. However, they do not usually cause severe symptoms such as back pain and difficulty breathing. FNHTRs are generally less severe and are caused by the recipient’s immune response to donor white blood cells or cytokines in the transfused blood.

Choice B Reason:

Allergic reactions to blood transfusions can range from mild to severe. Mild reactions may include itching, hives, and rash, while severe reactions (anaphylaxis) can cause difficulty breathing and hypotension. However, allergic reactions do not typically cause back pain, which is more indicative of a hemolytic process.

Choice C Reason:

Fluid overload, also known as transfusion-associated circulatory overload (TACO), can occur when too much blood is transfused too quickly. Symptoms include dyspnea, hypertension, and pulmonary edema. While difficulty breathing is a symptom of fluid overload, chills and back pain are not typical features.

Choice D Reason:

Acute hemolytic transfusion reaction (AHTR) is the most likely cause of the patient’s symptoms. AHTR occurs when the recipient’s immune system attacks the transfused red blood cells, leading to their destruction. This reaction can cause severe symptoms such as chills, fever, back pain, and difficulty breathing. It is a medical emergency that requires immediate intervention to prevent serious complications, including kidney failure and shock.