4. 1 and 3

An electrocardiogram was obtained which showed sinus bradycardia. Atropine is the first drug of choice for symptomatic bradycardia (1). The dose is 0.5mg IV push and may repeat up to a total dose of 3mg. He responds with an increased in both heart rate and blood pressure. A review of his drugs reveals that he has been prescribed carvedilol, valsartan, prednisone, and tacrolimus. Initial laboratory revealed a Na+ 115 mEq/L, K+ 6.4 mEq/L, HCO3- 12 mEq/L, blood urea nitrogen (BUN) 70 mg/dL, and serum creatinine (SCr) of 3.16 mg/dL. His baseline Na+ was 120-130s mg/dL and SCr ~2 mg/dL.

He was transferred to Banner University Medical Center Phoenix for further care. 

Which of the following should be done? (Click on the correct answer to be directed to the third of six pages)

  1. Administer normal saline
  2. Administration of an AVP receptor antagonist with rapid correction of his hyponatremia to 135 mEq/L
  3. Hold his beta blocker
  4. 1 and 3
  5. All of the above

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