PLE-2149

PLE-2149

A 57-year-old man is brought to the emergency department 30 minutes after he was found on the floor of his house. He has renal failure but has missed his last two dialysis treatments. His renal failure was caused by inadvertent ingestion of ethylene glycol. Medications include amlodipine and doxazosin. On arrival, his temperature is 37.5 C (99.5 F), blood pressure is 150/100 mm Hg, pulse is 95/min and regular, and respirations are 24/min. His breathing is rapid and deep. Crackles are heard in the lung bases. Laboratory studies show: – Na+ 135 mEq/L – Cl- 102 mEq/L – K+ 7.1 mEq/L – HCO3- 12 mEq/L – pH 7.22 – PCO2 31 mmHg – PO2 61 mmHg An ECG shows peaked T-waves. It will be at least 45 minutes before dialysis can be started. What is the most appropriate next step in management?