Diabetes Mellitus USMLE Step 1 Practice Question
A 23-year-old woman with type 1 diabetes mellitus and vitiligo is brought to the emergency department with vomiting, abdominal pain, fever, and confusion. She is hypotensive despite receiving 2 liters of intravenous fluids. Physical examination shows diffuse skin hyperpigmentation. Laboratory studies show sodium 122 mEq/L, potassium 6.1 mEq/L, glucose 48 mg/dL, and creatinine 1.8 mg/dL. Which of the following is the best next step in management?
Answer choices
- AOral fludrocortisone only
- BOvernight low dose dexamethasone suppression test
- CThyroid hormone replacement before any other therapy
- DIntravenous propranolol
- EHigh dose intravenous hydrocortisone and aggressive intravenous fluidsCorrect answer
- FFludrocortisone 0.1 mg orally
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