A pregnant woman in her 32nd wk of gestation is given magnesium sulfate for pre-eclampsia. The earli- est clinical indication of hypermag- nesemia is 

Five days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to have a serum sodium level of 120 meq/L. Proper management would be 

A 50-year-old patient presents with symptomatic nephrolithiasis. He reports that he underwent a jejunoileal bypass for morbid obe- sity when he was 39. One would expect to find 

Following surgery, a patient develops oliguria. You believe the patient is hypovolemic, but before increasing intravenous fluids you seek corroborative data. This would include 

A 45-year-old woman with Crohn’s disease and a small intesti- nal fistula develops tetany during the 2nd wk of parenteral nutrition. The laboratory findings include Ca 8.2 meq/L; Na 135 meq/L; K 3.2 meq/L; C1 103 meq/L; PO4 2.4 meq/L; albumin 2.4; pH 7.48; 38 kPa; P 84 kPa; bicarbonate 25 meq/L. The most likely cause of the patient’s tetany is