A 19-year-old woman with a history of generalized anxiety disorder presents to the emergency department with acute onset palpitations, dizziness, and tingling around her mouth and fingers. She reports feeling anxious and "out of control." Vital signs show BP 128/74 mmHg, HR 115 bpm, RR 35/min, SpO2 99% on room air. Physical examination is notable for positive Chvostek sign. Arterial blood gas analysis reveals: pH 7.54, PaCO2 26 mmHg, HCO3- 23 mEq/L. Serum calcium 8.6 mg/dL (normal 8.5-10.2), magnesium 1.8 mEq/L (normal), phosphate normal. ECG shows sinus tachycardia with no ischemic changes. Which of the following is the most appropriate next step in management?
- A)Administer intravenous calcium gluconate
- B)Start supplemental oxygen at 2 L/min via nasal cannula
- C)Obtain chest radiograph and measure troponin levels
- D)Instruct the patient to rebreathe expired air using a paper bag or plastic bagGABARITO
- E)Administer sodium bicarbonate 50 mEq intravenously over 5 minutes
Explicação
This patient presents with primary respiratory alkalosis (pH 7.54, PaCO2 26, normal HCO3-) secondary to hyperventilation from anxiety. The clinical presentation (anxiety disorder, palpitations, circumoral paresthesias, positive Chvostek sign) combined with the... Ver explicação completa e trilha adaptativa →