Viva 3

Scenario:    A 70-year-old female has been transferred  from a  regional  hospital with a  2-week history of profuse  diarrhoea.   She has a Glasgow Coma Score of 15 but looks unwell with a dry tongue.  Her temperature is 38˚C, her pulse is 130/min, and her blood pressure is 110/70.  The pulse oximeter reads 98% on oxygen via facemask of 6 L/minute.
Her serum biochemistry is as follows:

TEST

RESULT

UNITS

RANGE

Sodium

123

mmol/L

136-146

Potassium

7.0

mmol/L

3.5-5.2

Chloride

108

mmol/L

98-109

Bicarbonate

12

mmol/L

20-33

Urea

28

mmol/L

3.0-8.0

Creatinine

0.22

mmol/L

0.06-0.12

Glucose

4.3

mmol/L

3.0-6.5

Albumin

23

G/L

35-50

Introductory Question:  What would be your initial management of this patient?

Eighteen out of twenty-eight candidates passed this section.

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.