Toxicology

drug absorption together with the airway safety concern

(Answer C is incorrect). Administration of intravenous

fluids would be beneficial to improve BP but should not

be administered in this case before naloxone (Answer D

is incorrect).

Answer: D

The patient is not responding to the initiation of intrave-

nous fluids and calcium gluconate, so HIET is warranted.

Because of the patient’s low serum potassium concen-

trations, it is critical to replace this before administering

insulin (Answer A is incorrect and Answer D is correct).

The patient’s glucose concentration is greater than 200

mg/dL, so additional glucose need not be given at this

time (Answer B is incorrect). Full effects may take up

to 30 minutes to be seen, but this should not prevent the

initiation of HIET (Answer C is incorrect).

Answer: B

The patient is not responding to the initiation of intra-

venous fluids, calcium, and HIET. The most appropriate

option at this time would be to increase the rate of the

insulin infusion and initiate vasopressor therapy to

improve hemodynamic stability in the interim (Answer

B is correct). The initial infusion rate is 0.5–1 unit/kg/

hour and is titrated every 15–20 minutes until hemody-

namically stable. The next option would be to initiate

a vasopressor agent (Answers A and C are incorrect).

From the choices listed, the best first option is norepi-

nephrine initiated at 4 mcg/minute and titrated to the

desired effect. Epinephrine is also a possible option, but

it would be recommended if the patient were not respond-

ing to increasing doses of norepinephrine. Intravenous

lipid emulsion is a potential therapy, but it is typically

administered in a patient with severe decompensation

caused by a lipophilic medication who is not responding

to fluids or vasopressors (Answer D is incorrect).