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Full Version: Acute pancreatitis
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A 42-year-old man with alcohol dependence is admitted to the hospital for acute pancreatitis. Upon admission, he has an abdominal CT scan that shows edema without necrosis or hemorrhage of the pancreas. He is treated with IV fluids with dextrose, multivitamins, thiamine 50 mg daily, pain control, and bowel rest. He typically drinks 24 12-ounce beers daily. Forty-eight hours after admission, you are called because the patient is febrile and combative with the nursing staff. His vital signs demonstrate a heart rate of 132 beats/min, blood pressure of 184/96 mmHg, respiratory rate of 32 breaths/min, temperature of 38.7°C (101.7°F), and oxygen saturation of 94% on room air. He is agitated, diaphoretic, and pacing his room. He is oriented to person only. His neurologic examination appears nonfocal, although he does not cooperate. He is tremulous.

What is the next step in the management of this patient?

A. Administer a bolus of 1 L of normal saline and thiamine 100 mg IV.
B. Administer diazepam 10–20 mg IV followed by bolus doses of 5–10 mg as needed until the patient is calm but able to be aroused.
C. Perform an emergent head CT.
D. Perform two peripheral blood cultures and begin treatment with imipenem 1 g IV every 8 hours.
E. Place the patient in four-point restraints and treat with haloperidol 5 mg IV.

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