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
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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Related Questions
Correct Answer is A
Explanation
A. Paralytic ileus: Paralytic ileus is a common complication of major abdominal surgery and prolonged bed rest. It is a temporary cessation of normal bowel peristalsis, leading to a lack of bowel sounds and the inability to pass gas or stool.
B. Esophageal dysplasia: This condition refers to abnormal changes in the cells of the esophagus, typically related to chronic gastroesophageal reflux disease (GERD), not prolonged bed rest.
C. Gastroparesis: This is a condition in which the stomach cannot empty itself of food in a normal fashion, often related to diabetes or damage to the vagus nerve. It is not a direct result of prolonged bed rest.
D. Paralytic ileum: This should refer to "paralytic ileus."
Correct Answer is D
Explanation
A. Vertigo and bilateral loss of the pupillary light reflex: Vertigo can occur with cerebellar involvement, but loss of the pupillary light reflex is more associated with brainstem damage.
B. Nuchal rigidity and positive Kernig's sign: These are signs of meningitis, not a cerebellar stroke.
C. Report of falling down, nausea, and vomiting: These symptoms can occur with cerebellar strokes, but they are nonspecific and can be seen in other conditions as well.
D. Difficulty speaking and loss of coordination: The cerebellum is responsible for coordination, and a cerebellar stroke can lead to ataxia (loss of coordination) and dysarthria (difficulty speaking).
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