Question

A 25-year-old with type 1 diabetes presents with vomiting and abdominal pain. Glucose 520 mg/dL, pH 7.10, HCO3 10 mEq/L, anion gap 24, K 4.8 mEq/L. After 2 L of isotonic crystalloid, what is the best next step?

Accepted Answer

Start regular insulin infusion at 0.1 units/kg/hour (no bolus) and add dextrose when glucose <200 mg/dL

Answer

Give 10 units IV insulin bolus and then 10 units/hour infusion

Answer

Begin bicarbonate infusion because pH is 7.10

Answer

Delay insulin until potassium <3.3 mEq/L

Answer

Start insulin plus routine potassium infusion despite K 4.8 mEq/L

Practice question

A 25-year-old with type 1 diabetes presents with vomiting and abdominal pain. Glucose 520 mg/dL, pH 7.10, HCO3 10 mEq/L, anion gap 24, K 4.8 mEq/L. After 2 L of isotonic crystalloid, what is the best next step?