Approach to postoperative hypotension Quiz: Ace Your Exams
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A 49-year-old woman is admitted to the hospital for a right femoral neck fracture after falling from standing height. The patient had surgical fixation with no intraoperative complications. Several hours later, she developed hypotension. Her past medical history is significant for severe active rheumatoid arthritis. The patient cannot recall her home medications. Temperature is 36.1 ºC (97.0 ºF), pulse is 98/min, respiratory rate is 20/min, blood pressure is 77/42 mmHg, and SpO2 is 98% on room air. The patient is given two liters of normal saline solution. A repeat blood pressure is 83/47 mmHg. On physical examination, the patient is lethargic. Mucous membranes are moist. Cardiopulmonary auscultation is unremarkable. Electrocardiogram shows normal sinus rhythm without ST segment or T wave changes. Bloodwork is obtained and shown below. Which of the following is most likely to be found on further examination or history?
| Laboratory Test | Result |
| Troponin I | < 0.04 ng/mL |
| Sodium | 127 mEq/L |
| Potassium | 5.6 mEq/L |
| Bicarbonate | 19 mEq/L |
| Hemoglobin | 13.0 g/dL |
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