Question

A 24-year-old man with type 1 diabetes mellitus presents with nausea, vomiting, abdominal pain, and polyuria. Labs show: glucose 480 mg/dL, pH 7.15, bicarbonate 10 mEq/L, anion gap 24, and positive serum ketones. His serum potassium is 4.5 mEq/L and he is mildly dehydrated but hemodynamically stable. After starting isotonic fluids, what is the most appropriate next step in management?

Accepted Answer

Start IV insulin infusion at 0.1 units/kg/hour and begin potassium replacement if the level falls below 5.3 mEq/L.

Answer

Start a continuous IV insulin infusion immediately and continue without potassium monitoring.

Answer

Begin subcutaneous rapid-acting insulin every 6 hours with no IV insulin.

Answer

Delay insulin for 6 hours while giving bicarbonate infusion.

Answer

Administer an IV insulin bolus only, without continuous infusion.

Practice question