Question

A 28-year-old with type 1 diabetes presents with DKA: glucose 520 mg/dL, pH 7.12, bicarbonate 10 mEq/L, anion gap 26, K⁺ 4.6 mEq/L, creatinine 1.0 mg/dL. After 1-2 L isotonic crystalloid and confirming K⁺ ≥3.3 mEq/L, the next step is:

Accepted Answer

Start IV regular insulin 0.1 units/kg/hr (with or without 0.1 units/kg bolus)

Answer

Immediate subcutaneous rapid-acting insulin every hour

Answer

Start insulin infusion at 0.05 units/kg/hr

Answer

Hold insulin until glucose <250 mg/dL

Answer

Give bicarbonate routinely for pH 7.12

Practice question

A 28-year-old with type 1 diabetes presents with DKA: glucose 520 mg/dL, pH 7.12, bicarbonate 10 mEq/L, anion gap 26, K⁺ 4.6 mEq/L, creatinine 1.0 mg/dL. After 1-2 L isotonic crystalloid and confirming K⁺ ≥3.3 mEq/L, the next step is: