A 62-Year-Old Man Is Brought to the Emergency Department Because

question 54

Multiple Choice

A 62-year-old man is brought to the emergency department because of watery diarrhea, skin rash, and confusion.  He has had diarrhea for the past 1-2 days and took some over-the-counter medicines.  He returned from a cruise to Mexico 4 days ago.  He ate shellfish and raw oysters with fried rice at a local restaurant 2 days ago.
His other medical problems include alcoholic liver cirrhosis, type 2 diabetes mellitus, hypertension, and mild chronic kidney disease.  His medications include spironolactone, long-acting insulin, and propranolol.  He is an ex-smoker and drinks 1-2 cans of beer on weekends.  He occasionally smokes crack cocaine and marijuana.
His temperature is 38.9 C (102 F) , blood pressure is 70/30 mm Hg, pulse is 124/min, and respirations are 22/min.  Examination shows bilateral basal crackles.  The abdomen is distended and non-tender.  His skin shows multiple bullous lesions.
Laboratory results are as follows:
Despite aggressive fluid resuscitation and antibiotics, the patient dies in the emergency department.
Which of the following is most likely responsible for this patient's initial presentation?

• A)Crack cocaine abuse
• B)Cruise ship
• C)Fried rice consumption
• D)Mexico visit
• E)Seafood consumption

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Definitions:

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