Question

A 72-year-old man with type 2 diabetes presents with 3 days of lethargy and confusion. Capillary glucose is 38 mmol per litre, calculated serum osmolality 330 mOsm per kg, pH 7.36 and blood ketones 0.5 mmol per litre. What is the most appropriate first-line fluid management?

Accepted Answer

0.9 percent sodium chloride infused more slowly over 24 hours with careful monitoring

Answer

Rapid intravenous boluses of 0.9 percent sodium chloride aiming for 6 litres in the first 6 hours

Answer

5 percent dextrose at 500 mL per hour as sole fluid

Answer

No intravenous fluids to avoid cerebral oedema

Answer

Hypotonic saline 0.45 percent at 1 litre per hour as initial fluid

Practice question

A 72-year-old man with type 2 diabetes presents with 3 days of lethargy and confusion. Capillary glucose is 38 mmol per litre, calculated serum osmolality 330 mOsm per kg, pH 7.36 and blood ketones 0.5 mmol per litre. What is the most appropriate first-line fluid management?