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Cardiology
arrhythmias
sinus tachycardia
A 64-year-old woman is admitted to the medical ward presenting with a 4-day history of escalating fever, profound dizziness, and recurrent vomiting. She reports inability to tolerate oral intake and persistent temperatures exceeding 38.5°C despite home remedies. Accompanying symptoms include generalized malaise, rhinorrhea, nasal congestion, and a mild, non-productive cough. Her medical history includes well-controlled essential hypertension. On examination, she appears acutely ill and lethargic. Her vital signs are notable for a blood pressure of 90/60 mm Hg, a pulse rate of 118 beats/min, respiratory rate of 20 breaths/min, and an oral temperature of 39.1°C. Physical examination reveals dry mucous membranes, reduced skin turgor, and a capillary refill time of 4 seconds. Cardiopulmonary auscultation is unremarkable save for the regular, rapid heart rate. Rapid molecular testing for respiratory pathogens confirms the presence of influenza A virus. Considering her current clinical state, what is the most appropriate initial diagnosis and subsequent management plan?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| White Blood Cell Count | 13.5 x 10^9/L | 4.0-11.0 x 10^9/L |
| Hemoglobin | 135 g/L | 120-150 g/L |
| Platelets | 280 x 10^9/L | 150-450 x 10^9/L |
| Sodium | 148 mmol/L | 135-145 mmol/L |
| Potassium | 4.1 mmol/L | 3.5-5.0 mmol/L |
| Chloride | 108 mmol/L | 98-107 mmol/L |
| Bicarbonate | 20 mmol/L | 22-29 mmol/L |
| Blood Urea Nitrogen (BUN) | 10.5 mmol/L | 2.5-8.0 mmol/L |
| Creatinine | 110 µmol/L | 45-90 µmol/L |
| Urine Specific Gravity | 1.030 | 1.005-1.030 |
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