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128511 Medicine

A female patient has primary adrenal insufficiency. She is on hydrocoisone 15 mg a day and fludrocoisone 0.1 mg daily. She becomes acutely ill after eating raw oysters. She has severe, “cramping” abdominal pain and profuse watery diarrhea. Vital signs show a hea rate of 135 bpm, respiration rate of 28 bpm, blood pressure of 72/25 mm Hg, and temperature of 38.1degC. The exam shows tachycardia, dry oral mucosa, clear lungs, and diffuse abdominal tenderness. A rectal exam is heme negative. There are no skin rashes. Which of the following is most appropriate for the initial management of this patient?

ASaline bolus
BDobutamine
CD5 half-normal saline at 100 cc/hour
DCT of abdomen and pelvis
Medicine
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