Question

A 59-year-old man with type 2 diabetes presents with polyuria and abdominal pain. Labs: glucose 560 mg/dL, pH 6.85, bicarbonate 5 mEq/L, K⁺ 4.9 mEq/L, anion gap 28, beta-hydroxybutyrate elevated. Which additional therapy is specifically indicated by the severity of acidosis?

Accepted Answer

No bicarbonate; start insulin and fluids only

Answer

Bolus 100 mEq sodium bicarbonate if pH <7.2

Answer

Continuous bicarbonate infusion for 6 hours if pH <7.0

Answer

Bicarbonate if pH <6.9

Answer

Administer tromethamine (THAM)

Practice question

A 59-year-old man with type 2 diabetes presents with polyuria and abdominal pain. Labs: glucose 560 mg/dL, pH 6.85, bicarbonate 5 mEq/L, K⁺ 4.9 mEq/L, anion gap 28, beta-hydroxybutyrate elevated. Which additional therapy is specifically indicated by the severity of acidosis?