Question

A 35-year-old with known type 1 diabetes presents with polyuria, Kussmaul respirations, and abdominal pain. Labs: glucose 482 mg/dL, pH 7.21, bicarbonate 12 mEq/L, anion gap 22, K+ 3.6 mEq/L. After initial 1 L isotonic crystalloid, which management step is most appropriate?

Accepted Answer

Start IV regular insulin at 0.1 units/kg/h and add 5-10% dextrose to IV fluids when plasma glucose falls below 250 mg/dL while continuing insulin to clear ketones.

Answer

Start IV regular insulin at 0.05 units/kg/h and add dextrose when glucose <300 mg/dL.

Answer

Give IV sodium bicarbonate now for pH 7.21.

Answer

Use subcutaneous long-acting insulin only; avoid IV insulin.

Answer

Hold insulin infusion because K+ is <3.8 mEq/L.

Practice question

A 35-year-old with known type 1 diabetes presents with polyuria, Kussmaul respirations, and abdominal pain. Labs: glucose 482 mg/dL, pH 7.21, bicarbonate 12 mEq/L, anion gap 22, K+ 3.6 mEq/L. After initial 1 L isotonic crystalloid, which management step is most appropriate?