A 55-year-old man with known plaque psoriasis on methotrexate presents with sudden onset generalized erythema, scaling, and desquamation involving 92% BSA over 5 days. He is hypothermic and hypotensive. Which metabolic abnormality is most critical to correct immediately?

• A Hypocalcemia due to epidermal calcium loss
• B Hypoalbuminemia due to protein loss through denuded skin ✓
• C Hypernatremia due to transepidermal water loss
• D Hyperglycemia due to stress response

Explanation

Erythroderma causes massive protein loss through the denuded skin surface, leading to severe hypoalbuminemia. This results in edema, impaired drug binding, and contributes to hemodynamic instability. While transepidermal water and electrolyte losses are significant, hypoalbuminemia is the most critical metabolic parameter as it affects drug pharmacokinetics, oncotic pressure, and wound healing. Aggressive protein supplementation and monitoring are essential in erythroderma management.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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