Question

A 24-year-old man with type 1 diabetes presents with abdominal pain, nausea and increasing drowsiness. He has missed several insulin doses. Capillary glucose is 28 mmol/L, ketones 4.5 mmol/L and venous blood gas shows pH 7.12 and bicarbonate 10 mmol/L. He has already received a 1 L bolus of 0.9% saline. What is the most appropriate next step in management?

Accepted Answer

Start a fixed-rate intravenous insulin infusion with potassium monitoring

Answer

Give an intravenous bolus of rapid-acting insulin followed by a sliding scale

Answer

Restrict fluids and give only subcutaneous insulin

Answer

Start an intravenous infusion of 5% dextrose immediately

Answer

Administer intravenous Sodium bicarbonate as first-line treatment

Practice question