Answer to Question 1
Correct Answer: 1
Isotonic (0.9 normal saline) or slightly hypertonic (lactated Ringer's) IV solutions are used in the patient with LOC. Hypotonic solutions (such as 0.45 saline, D5W and D5W in 0.45 normal saline) will cause fluid to move into the cells and worsen cerebral edema. Highly hypertonic solutions will cause fluid to move out of the cells.
Answer to Question 2
Correct Answer: 1
Blood glucose is measured immediately when coma or decreased LOC is of unknown origin. When the glucose falls to less than 50 mg/dL, cerebral function declines rapidly and hypoglycemia should be suspected. Serum osmolality of less than 250 mOsm/kg H2O leads to cerebral edema and swelling, impairing consciousness. The other lab values are normal.