Question

A 25-year-old woman with type 1 diabetes presents with abdominal pain and vomiting. Labs: glucose 520 mg/dL, pH 7.09, bicarbonate 8 mEq/L, anion gap 24, serum K⁺ 2.9 mEq/L, creatinine 1.0 mg/dL. After initial isotonic fluids, what is the next best step?

Accepted Answer

Hold insulin and aggressively replete potassium until K⁺ ≥3.3 mEq/L

Answer

Start IV regular insulin infusion at 0.14 units/kg/hr immediately

Answer

Give sodium bicarbonate bolus

Answer

Begin insulin infusion only after giving 40 mEq KCl when K⁺ <5.0

Answer

Switch to 0.45% saline to avoid hyperchloremia

Practice question

A 25-year-old woman with type 1 diabetes presents with abdominal pain and vomiting. Labs: glucose 520 mg/dL, pH 7.09, bicarbonate 8 mEq/L, anion gap 24, serum K⁺ 2.9 mEq/L, creatinine 1.0 mg/dL. After initial isotonic fluids, what is the next best step?