4. 1 and 3

The patient is hypotensive and beside echocardiography has been shown to be helpful in patient management (1). The patient’s ejection fraction was estimated to be 30% with global hypokinesis. Inferior vena cava size was 2.6 cm. Urine drug screen was positive only for benzodiazepines. She had been receiving midazolam for sedation and as an anticonvulsant. Although liver enzymes are abnormal, liver biopsy at this juncture is risky and not indicated.

Additional laboratory that was obtained included blood cultures, N-terminal pro-brain naturetic peptide 18,615 (normal < 300 pg/mL), and lactate was elevated at 3.8 (normal < 2 mmol/L).

Which of the following are indicated based on the initial laboratory evaluation? (Click on the correct answer to proceed to the third of five pages)

  1. Broad spectrum antibiotics
  2. Intravenous glucose
  3. Stress dose corticosteroids
  4. 1 and 3
  5. All of the above

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