Question

A 28-year-old woman with type 1 diabetes presents to the emergency department with nausea, abdominal pain, and polyuria. Vitals: T 37.8°C, HR 112/min, BP 110/68 mm Hg, RR 26/min, Kussmaul respirations. Capillary glucose is 25 mmol/L. Venous blood gas shows pH 7.18 and bicarbonate 11 mmol/L. Serum ketones are elevated. What is the most appropriate initial management step?

Accepted Answer

Begin rapid intravenous isotonic fluid resuscitation and then commence insulin infusion

Answer

Start an intravenous insulin infusion at 0.1 units/kg/h immediately before fluids

Answer

Administer a bolus of intravenous insulin 0.3 units/kg then start infusion

Answer

Give intravenous sodium bicarbonate immediately

Answer

Start long-acting subcutaneous insulin only and encourage oral fluids

Practice question