KB is a 65-year-old man admitted to the hospital after a 5-day episode of "the flu" with symptoms of dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. KB was diagnosed with Graves' disease 6 months ago and placed on methimazole (Tapazole) 15 mg/day. His other past medical history includes heart failure and hypertension requiring antihypertensive medications; however, he says that he has not been taking these medications on a regular basis. Vital signs (VS) are 150/90, 124 irregular, 20, 100.2°F (37.9°C). Admission assessment findings are height 5 ft 8 in (173 cm), weight 132 lb (60 kg), appears anxious and restless, loud heart sounds, bounding radial pulses, 1+ pitting edema noted in bilateral lower extremities, diminished breath sounds with fine crackles in the posterior bases, and hyperactive bowel sounds. KB begins to cry when he tells you he recently lost his wife. You notice someone has punched several more holes in his belt so he could tighten it.

Which of KB's assessment findings represent manifestations of hypermetabolism related to the effect of excess circulating thyroid hormone? Select all that apply.

Choice A reason:
Increasing serum potassium levels would not indicate effective therapy for a patient with Addison's disease. In Addison's disease, the adrenal glands do not produce enough aldosterone, which is responsible for regulating sodium and potassium balance. As a result, patients with Addison’s disease often experience hyperkalemia (high potassium levels). Effective therapy typically aims to normalize potassium levels, so an increase would suggest inadequate treatment or worsening of the condition.
Choice B reason:
Decreasing blood glucose levels would not typically be seen as a positive indicator in a patient with Addison's disease. The body’s ability to maintain normal blood glucose levels is compromised in Addison’s disease due to a deficiency in cortisol. Cortisol plays a key role in regulating glucose metabolism, and its deficiency can lead to hypoglycemia (low blood glucose levels). If blood glucose levels are decreasing, it may indicate inadequate glucocorticoid replacement therapy, suggesting the therapy is not fully effective.
Choice C reason:
Decreasing serum chloride levels would not be expected in a patient with Addison’s disease who is receiving proper treatment. Chloride is regulated alongside sodium and is influenced by aldosterone. In Addison's disease, aldosterone deficiency leads to a decreased ability to retain sodium, which in turn can affect chloride levels. However, a decrease in chloride levels alone is not a clear sign of effective therapy. Normalization of serum sodium levels is a better indicator of treatment success.
Choice D reason:
Increasing serum sodium levels is the correct finding that indicates effective therapy in a patient with Addison’s disease. In this condition, aldosterone deficiency results in sodium loss through the kidneys, leading to hyponatremia (low sodium levels). Effective therapy, which typically involves the administration of glucocorticoids and mineralocorticoids (such as fludrocortisone), helps to correct this imbalance by increasing sodium retention and normalizing serum sodium levels. This would demonstrate that the current therapies are working to restore the electrolyte balance.

Choice A reason: "It must have been from sharing needles with my roommate." This statement is incorrect because hepatitis A is not typically transmitted through sharing needles. Hepatitis A is primarily spread through the fecal-oral route, which involves ingestion of contaminated food or water.
Choice B reason: "It is likely transmitted through kissing or sexual activity." This statement is also incorrect. Hepatitis A is not commonly spread through kissing or sexual activity. It is mainly transmitted through consuming contaminated food or water or close contact with an infected person.
Choice C reason: "I think I caught it because I have a family history of liver problems." This statement reflects a misunderstanding of how hepatitis A is transmitted. Hepatitis A is not linked to genetic predisposition or family history of liver problems. It is an infectious disease spread through the fecal-oral route.
Choice D reason: "I probably got it from drinking contaminated water or eating food handled by someone who didn't wash their hands properly." This statement is correct and indicates an accurate understanding of how hepatitis A is transmitted. The virus is often spread through consumption of contaminated food or water, particularly in areas with poor sanitation.