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Diabetic ketoacidosis — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesDiabetic ketoacidosisSCE Acute Medicine

A 73-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show glucose 28, ketones 6.2, pH 7.12 and missed insulin. What is the most appropriate next step in management?

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

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Correct answer: A — Start fixed-rate intravenous insulin with fluids and potassium protocol

The key discriminator is that glucose 28, ketones 6.2, pH 7.12 and missed insulin, which makes Start fixed-rate intravenous insulin with fluids and potassium protocol the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Provide supportive care and close monitoring are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: JBDS DKA guideline; BNF