Question

A 23-year-old woman with type 1 diabetes presents with abdominal pain, vomiting and polyuria. Capillary glucose is 27 mmol/L and urine ketones are strongly positive. Arterial blood gas shows pH 7.10 and bicarbonate 10 mmol/L. She is drowsy but rousable and systolic BP is 102 mmHg. After ABCDE assessment, what is the most appropriate initial fluid management?

Accepted Answer

Give 1 L of 0.9% sodium chloride over 1 hour via a large-bore cannula.

Answer

Give a rapid 1 L bolus of 0.45% sodium chloride over 15 minutes.

Answer

Start an infusion of 10% glucose at 100 mL/hour.

Answer

Withhold IV fluids until a central venous pressure line is inserted.

Answer

Give 500 mL of 0.9% sodium chloride over 4 hours.

Practice question