A 22-year-old with type 1 diabetes has vomiting, deep rapid breathing, glucose 28 mmol/L, pH 7.1 and potassium 4.2 mmol/L. What is the best initial management?
Answer and explanation
Correct answer: C. Isotonic saline resuscitation, then a continuous insulin infusion with potassium monitoring
- Step 1: The picture is diabetic ketoacidosis with a potassium that is safe to start insulin. Step 2. Volume replacement comes first because patients are deeply dry; insulin then stops ketone production while potassium is watched closely. Answer: fluids then an insulin infusion. Why not the others: bicarbonate is rarely needed at this pH, and oral or subcutaneous plans are too slow for severe acidosis.
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