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Diabetic Ketoacidosis — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesDiabetic KetoacidosisRACP Adult Medicine

A 30-year-old woman with type 1 diabetes presents with nausea, vomiting, and abdominal pain. Her blood glucose is 18 mmol/L, pH 7.15, bicarbonate 8 mmol/L, and serum ketones 5.8 mmol/L. Serum potassium is 5.8 mmol/L. After commencing IV normal saline, what is the next priority?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — IV insulin infusion at 0.1 units/kg/hour

In DKA, the priority after fluid resuscitation is commencement of a fixed-rate IV insulin infusion (0.1 units/kg/hr). Despite the elevated serum potassium of 5.8 mmol/L, potassium replacement should NOT be commenced until K+ falls below 5.5 mmol/L (as insulin will drive potassium intracellularly). Potassium should be checked every 1–2 hours. Bicarbonate is not routinely recommended unless pH <6.9.

Reference: eTG – 2025 – Endocrinology; ADS – 2023 – DKA Management Protocol