A 36-year-old woman is admitted for dizziness, weakness, poor appetite, fatigue, and salt-craving for 4 weeks. She has history of asthma, and not on any medications. She has a family history of type 1 diabetes and hypothyroidism. On admission, her blood pressure (BP) is 100/60 mmHg with a pulse rate of 100 (sitting), and 80/48 mmHg with a pulse rate of 120 beats/min (standing). Her temperature is 99.6 F. Laboratory values are as follows: 



Na+= 1⁄4 124 mEq=L 

K+ =1⁄4 6:1 mEq=L 

Cl- =1⁄4 114 mEq=L 

HCO3 1⁄4 20mEq=L 

BUN= 1⁄4 42 mgdL



Creatinine=1⁄4 1:8 mg/dL 

Glucose 1⁄4= 50 mg/dL 

Hemoglobin=1⁄4 13 g=dL 

Hematocrit=1⁄4 40% 

Urinary Naþ 1⁄4 60 mEq/L 



Based on the above history and laboratory values, which one of the following fluids is APPROPRIATE in addition to pertinent hormone administration? 

A 24-year-old woman is admitted for fever with chills and weakness. She is found to be hypotensive and tachycardic. Blood cultures are positive for Staphylococcus aureus, and the diagnosis of septic shock is made. There is no peripheral edema. Based on the sensitivity, the patient is started on vancomycin. Pertinent labs: 



Na+ =1⁄4 144 mEq/L

K+ =1⁄4 5.1 mEq/L

Cl- =1⁄4 88 mEq/L 

HCO3- =1⁄4 20 mEq/L 

BUN 1⁄4 =30 mg/dL 

Creatinine =1⁄4 1.7 mg/dL 



Glucose =1⁄4 80 mg/dL

Total protein= 1⁄4 5.8 g/dL 

Albumin =1⁄4 2.0 g/dL 

Hemoglobin =1⁄4 10 g/dL 

Hematocrit =1⁄4 30 % 

Urinary Na+ =1⁄4 10 mEq/L 



Which one of the following fluids is APPROPRIATE for initial resuscitation? 

A 72-year-old man with history of hypertension, type 2 diabetes, coronary artery disease with stent placement, and CHF is admitted for dyspnea at rest. He noticed swelling of his legs for 4 weeks despite salt restriction and diuretics. His LV ejection fraction (EF) is 40 %. Medications include humalog (75/25) 20 units QD, furosemide 40 mg BID, metolazone 2.5 mg QD, spironolactone 12.5 mg QD, carvedilol 12.5 mg BID, ramipril 10 mg QD, atorvastatin 40 mg QD, clopidogrel 75 mg QD, and aspirin 81 mg QD. BP 100/60 mmHg, pulse 102 beats/min, marked JVD, crackles, an S3, positive hepatojugular reflex, and pitting edema up to knees. Labs: Na+ 134 mEq/L, K+ 3.8 mEq/L, Cl 90 mEq/L, HCO3 28 mEq/L, BUN 46 mg/dL, creatinine 1.8 mg/dL, eGFR <60 mL/min, and glucose 100 mg/dL. HgbA1c 7 %. Urinalysis is significant for 2+ proteinuria. EKG shows tachycardia. He weighs 98 kg. 



Based on the above history and lab values, which one of the following is the MOST appropriate initial management in this patient?