The young F gets iv reglan, saline, zofran, and keeps on dry-heaving. Her chemistries come back. How shall we proceed?
Jacobi / Montefiore Emergency Medicine Residency
Jacobi / Montefiore Emergency Medicine Residency
The young F gets iv reglan, saline, zofran, and keeps on dry-heaving. Her chemistries come back. How shall we proceed?
Serum Osmol, ketones, ASA lvl, UA with micro, VBG w/lactate, and EtOH
Any tox labs: asa, etc?
How much NS has she gotten? This is metabolic acidosis w/ AG 25, delta ratio suggestive of pure HAGMA, etiology still unclear. Making ketones? Hcg? If ketosis can switch to D5. Seems unlikely etiology is lactate/tox, and she is clearly not uremic.
Would try another antiemetic (compazine, phenergan, could try an antihistamine), c/w IVF, replete potassium and reassess to see if she is clinically improving. And I would get a CXR if she is retching a lot.
Is she complaining of anything else (abd pain, headache, dizziness)? Anything suggestive on exam (tender belly etc)?