Question

A 27-year-old with diabetic ketoacidosis (pH 7.12, HCO₃⁻ 9 mEq/L, anion gap 26) has serum K⁺ = 2.9 mEq/L and glucose 512 mg/dL. After 1 L isotonic crystalloid, what is the next best step?

Accepted Answer

Hold insulin and give IV potassium to raise K⁺ to ≥3.3 mEq/L

Answer

Start IV regular insulin at 0.1 U/kg/h now

Answer

Give IV sodium bicarbonate

Answer

Stop fluids and start D5½NS now

Answer

Begin subcutaneous rapid-acting insulin every hour

Practice question

A 27-year-old with diabetic ketoacidosis (pH 7.12, HCO₃⁻ 9 mEq/L, anion gap 26) has serum K⁺ = 2.9 mEq/L and glucose 512 mg/dL. After 1 L isotonic crystalloid, what is the next best step?