A 54-year-old with obesity and T2D presents with hyperosmolar hyperglycaemic state: glucose 980 mg/dL, pH 7.35, osmolality 330 mOsm/kg, no significant...

Question

A 54-year-old with obesity and T2D presents with hyperosmolar hyperglycaemic state: glucose 980 mg/dL, pH 7.35, osmolality 330 mOsm/kg, no significant ketones, normal K⁺. First therapeutic priority?

Accepted Answer

Aggressive isotonic fluid resuscitation with IV crystalloids

Answer

Start IV insulin bolus then infusion immediately

Answer

Sodium bicarbonate infusion

Answer

Immediate potassium replacement before fluids

Answer

Start subcutaneous insulin only

us-abem MCQ (SBA): Hyperosmolar hyperglycaemic state

A 54-year-old with obesity and T2D presents with hyperosmolar hyperglycaemic state: glucose 980 mg/dL, pH 7.35, osmolality 330 mOsm/kg, no significant ketones, normal K⁺. First therapeutic priority?