A 24-year-old with type 1 diabetes presents with DKA: glucose 522 mg/dL, pH 7.12, HCO₃⁻ 9 mEq/L, anion gap 24. Serum K⁺ is 2.9 mEq/L. After 1 L isoton...

Question

A 24-year-old with type 1 diabetes presents with DKA: glucose 522 mg/dL, pH 7.12, HCO₃⁻ 9 mEq/L, anion gap 24. Serum K⁺ is 2.9 mEq/L. After 1 L isotonic crystalloid, what is the next best step?

Accepted Answer

Hold insulin and begin IV potassium (20-30 mEq/h) until K⁺ ≥3.3 mEq/L

Answer

Give 10 units IV regular insulin bolus and start 0.1 units/kg/h infusion

Answer

Start bicarbonate infusion until pH ≥7.3

Answer

Begin dextrose 5% in 0.45% saline immediately

Answer

Administer subcutaneous rapid-acting insulin every hour

us-abim MCQ (SBA): DKA

A 24-year-old with type 1 diabetes presents with DKA: glucose 522 mg/dL, pH 7.12, HCO₃⁻ 9 mEq/L, anion gap 24. Serum K⁺ is 2.9 mEq/L. After 1 L isotonic crystalloid, what is the next best step?