Question

A 72-year-old woman with type 2 diabetes presents with marked hyperglycaemia (glucose 38 mmol/L), profound dehydration, osmolality 335 mOsm/kg, but no significant ketonaemia or acidosis. She is drowsy but responsive. What is the most important immediate treatment priority?

Accepted Answer

Gradual intravenous fluid replacement with 0.9% sodium chloride

Answer

Rapid insulin bolus followed by infusion

Answer

Rapid correction of sodium with hypertonic saline

Answer

Immediate bicarbonate infusion

Answer

Start long-acting insulin and discharge when glucose falls

Practice question

A 72-year-old woman with type 2 diabetes presents with marked hyperglycaemia (glucose 38 mmol/L), profound dehydration, osmolality 335 mOsm/kg, but no significant ketonaemia or acidosis. She is drowsy but responsive. What is the most important immediate treatment priority?