A patient with diabetes mellitus (DM) developed a serum glucose of 900 and an elevated serum osmolality. The patient then became unconscious. What pathological process most likely caused the altered neurologic status?

The brain cells became edematous because of a blood to tissue shift of fluid.

Hyperinsulinemia caused hypoglycemia and a tonic clonic seizure.

The brain cells became dehydrated because of fluid shirting out of the cells.

Fluid volume overload caused higher pressure in the brain tissue

Answer and Explanation

The Correct Answer is C

A. The brain cells became edematous because of a blood to tissue shift of fluid: This describes cerebral edema, which is not typically caused by hyperglycemia.

B. Hyperinsulinemia caused hypoglycemia and a tonic-clonic seizure: The scenario describes hyperglycemia, not hypoglycemia.

C. The brain cells became dehydrated because of fluid shifting out of the cells:. In hyperglycemic hyperosmolar syndrome (HHS), extremely high blood glucose leads to increased serum osmolality, causing water to move out of brain cells, leading to dehydration and altered consciousness.

D. Fluid volume overload caused higher pressure in the brain tissue: Fluid volume overload is not the primary issue in this scenario; rather, dehydration is the concern due to hyperglycemia.

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Correct Answer is D

Explanation

A. Hyperproteinemia and increased drug effect: In cirrhosis, hypoproteinemia (low protein levels) occurs due to decreased protein synthesis by the liver, and drug metabolism is often impaired, leading to increased drug effects, but hyperproteinemia is not a typical finding.

B. Hyperkalemia and fluid retention: While fluid retention is common due to hypoalbuminemia and portal hypertension, hyperkalemia is not a direct consequence of hepatocyte dysfunction.

C. Hypercortisolism and increased infection risk: Hypercortisolism is not typically associated with cirrhosis. However, increased infection risk is common due to compromised immune function.

D. An elevated blood glucose and ammonia level: In cirrhosis, the liver's ability to metabolize ammonia is impaired, leading to elevated levels. Additionally, impaired glucose metabolism can result in hyperglycemia.

A. Genetic predisposition to the illness is rare in North American populations. B. The addition of iodide to salt helps lower the incidence in the US. C. There are better screening tools in the U.S. than in other countries. D. There are better medications more readily available to US citizens.

Correct Answer is B

Explanation

A. Decreased respirations and CO2 retention: A thyrotoxic crisis (thyroid storm) typically involves increased, not decreased, respiratory rates and CO2 retention due to increased metabolic activity.

B. Seizures and extreme tachycardia: Thyrotoxic crisis is characterized by severe symptoms including extreme tachycardia, fever, and potentially seizures due to excessive thyroid hormone levels.

C. Constipation and a swollen abdomen: Constipation and abdominal swelling are more typical of hypothyroidism rather than a thyrotoxic crisis.

D. Hypotension and bradycardia: Thyrotoxic crisis usually causes tachycardia and hypertension rather than bradycardia and hypotension.

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A patient with diabetes mellitus (DM) developed a serum glucose of 900 and an elevated serum osmolality. The patient then became unconscious. What pathological process most likely caused the altered neurologic status?

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