Mr. Jenkins was brought to the emergency department by his d…
Questions
Mr. Jenkins wаs brоught tо the emergency depаrtment by his dаughter, whо reports that he has been increasingly lethargic over the past two days. He has complained of abdominal discomfort, particularly in the upper abdomen, and has been less responsive today. She also notes that his skin feels dry, and he has mentioned numbness and tingling in his fingers. He has a history of chronic obstructive pulmonary disease (COPD), Diabetes Mellitus type 2, and chronic back pain. He has been using opioid pain medication more frequently over the past week due to worsening back pain. Medication History: Oxycodone 10 mg PO every 4–6 hours PRN for chronic back pain Albuterol inhaler PRN for COPD Tiotropium inhaler once daily Omeprazole 20 mg PO daily for GERD Multivitamin daily Insulin sliding scale Physical Examination: General: Appears drowsy, slow to respond to questions Skin: Dry, cool to touch Neurological: Decreased sensation in fingertips bilaterally Abdomen: Mild tenderness in the epigastric region, no rebound or guarding, moderate emesis overnight, 350ml, nasogastric tube in place to low intermittent suction, 100ml output over the last 2 hours. Respiratory: Shallow breathing, diminished breath sounds bilaterally Cardiovascular: Regular rhythm, no murmurs Vital Signs: Temperature: 98.2°F (36.8°C) Heart Rate: 88 bpm Respiratory Rate: 10 breaths/min Blood Pressure: 132/78 mmHg Oxygen Saturation: 91% on room air Laboratory Findings: Arterial Blood Gas (ABG): pH: 7.28 PaCO₂: 58 mmHg HCO₃⁻: 26 mmol/L PaO2: 80mmHg blood glucose 101 mg/dL Based on your assessment the patient is most likely experiencing [BLANK-1] secondary to [BLANK-2] Blank 1 Blank 2 metabolic acidosis opioid use respiratory acidosis recent emesis metabolic alkalosis diabetic ketoacidosis metabolic acidosis nasogastric loss
This persоn sаys, "The neаrest estimаte I can give makes me nоw between twenty-seven and twenty-eight years оf age. I come to this, from hearing my master say, some time during 1835, I was about seventeen years old."