Question

A 28-year-old woman with type 1 diabetes presents to the emergency department with 24 hours of polyuria, vomiting and abdominal pain. Her capillary glucose is 26 mmol/L; venous blood gas shows pH 7.14, bicarbonate 10 mmol/L and marked ketonaemia. She is tachycardic and dehydrated but haemodynamically stable. After initial assessment, which is the most appropriate immediate management sequence?

Accepted Answer

Commence rapid IV fluid resuscitation with 0.9% sodium chloride, then start a fixed-rate IV insulin infusion

Answer

Administer IV insulin bolus followed by insulin infusion; delay fluids until glucose is checked again

Answer

Give IV bicarbonate first to correct acidosis, then consider fluids

Answer

Start subcutaneous rapid-acting insulin without IV fluids

Answer

Start 10% glucose infusion immediately to prevent hypoglycaemia

Practice question