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A 22-year-old woman presents to the emergency department with nausea, vomiting, and abdominal
pain of 4 days' duration. Her fluid balance profile is as follows: Na+, 145; K+, 5.0; Cl-, 105; HCO3
-, 15;
BUN, 37; Cr, 1.6; glucose, 780; UA, 4+ ketones.
What is the best initial treatment of this patient's acid-base disorder?
. A. Free water
. B. Normal saline
. C. Normal saline, sodium bicarbonate, and insulin
. D. Half-normal saline and insulin
. E. Normal saline and insulin
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E. Normal saline and insulin.