Question

A 22-year-old woman with type 1 diabetes presents with abdominal pain, nausea and polyuria for 24 hours. Capillary blood glucose is 24 mmol/L, venous blood gas shows pH 7.18 and bicarbonate 12 mmol/L, and serum ketones are 4.5 mmol/L. She is tachycardic but normotensive. What is the most appropriate initial fluid management?

Accepted Answer

Bolus 20 mL/kg of 0.9% sodium chloride then start a fixed-rate insulin infusion

Answer

Start rapid-acting insulin subcutaneously and encourage oral fluids

Answer

Commence 5% dextrose infusion immediately

Answer

Give a bolus of 4% dextrose in 0.18% sodium chloride

Answer

Restrict fluids until blood glucose falls

Practice question