A 70-year-old man with type 2 diabetes presents confused, severely dehydrated and drowsy. His capillary glucose is 45 mmol/L, osmolality is markedly e...

Question

A 70-year-old man with type 2 diabetes presents confused, severely dehydrated and drowsy. His capillary glucose is 45 mmol/L, osmolality is markedly elevated, and ketones are not raised. Hyperosmolar hyperglycaemic state is diagnosed. What is the most important initial management priority?

Accepted Answer

Gradual fluid resuscitation with 0.9% sodium chloride

Answer

Immediate intravenous bolus of rapid-acting insulin

Answer

Rapid correction of hyperglycaemia with high-dose insulin infusion

Answer

Intravenous bicarbonate infusion

Answer

Oral rehydration solution and discharge once improved

uk-plab-1 MCQ (SBA): Hyperosmolar hyperglycaemic state

A 70-year-old man with type 2 diabetes presents confused, severely dehydrated and drowsy. His capillary glucose is 45 mmol/L, osmolality is markedly elevated, and ketones are not raised. Hyperosmolar hyperglycaemic state is diagnosed. What is the most important initial management priority?