A 19-year-old woman with type 1 diabetes presents with vomiting, abdominal pain and drowsiness. Glucose is 26 mmol/L, venous pH is 7.12, bicarbonate

Question

A 19-year-old woman with type 1 diabetes presents with vomiting, abdominal pain and drowsiness. Glucose is 26 mmol/L, venous pH is 7.12, bicarbonate is 9 mmol/L and serum ketones are elevated. Which of the following is the most appropriate initial management?

Accepted Answer

Isotonic intravenous fluids, intravenous insulin protocol and potassium-guided electrolyte replacement

Answer

Subcutaneous rapid-acting insulin only and discharge

Answer

Sodium bicarbonate routinely for all patients

Answer

Hold fluids until glucose is below 15 mmol/L

Answer

Start metformin after oral rehydration

Diabetic ketoacidosis — MCCQE Part 1 MCQ

A 19-year-old woman with type 1 diabetes presents with vomiting, abdominal pain and drowsiness. Glucose is 26 mmol/L, venous pH is 7.12, bicarbonate is 9 mmol/L and serum ketones are elevated. Which of the following is the most appropriate initial management?