Emergency Medicine Review Question of the Day

ABEM Exam Review Question of the Day, Courtesy of Med-Challenger

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A 50-year old woman is seen 24 hours after she reportedly ingested a large amount of iron. She says she ingested "2 handfuls" with vodka. Family members report that there were 2 nearly empty bottles of ferrous sulfate 325 mg, each with 60 pills, of which 12 were left. She was ill yesterday with nausea, vomiting, and abdominal pain. Today she reports feeling sad and regrets her actions yesterday. She has had no abdominal pain or nausea today and ate breakfast prior to her family's discovery of the overdose. Her estimated ingested dose is 82 mg/kg based on the worst-case scenario of pills missing. Her weight is 85 kg.

She takes hydrochlorothiazide for hypertension, vitamin D, and 81 mg aspirin daily.

Physical examination reveals that she is withdrawn but alert and cooperative. Her blood pressure is 140/90 mm Hg, pulse is 78 beats/minute, respiratory rate is 18 breaths/minute, and temperature is 37.0ºC.

Other results include the following:
Eyes: Normal pupils, no scleral icterus
Oral cavity: Moist
Chest and heart examination: Normal, good distal pulses
Abdomen: Soft, bowel sounds present, no focal tenderness
Skin: Warm and dry, no bruising
Neurologic: Normal motor tone, normal reflexes

Laboratory findings reveal the following:
Sodium: 136
Potassium: 3.5
Chloride: 108
Bicarbonate: 21 mEq/L

Blood urea nitrogen is 24 mg/dL and creatinine is 1.5 mg/dL. Hemoglobin is 13.1 g/dL.

Which statement best applies to this patient?

Remaining Tries: 2

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