A 23-year-old woman with type 1 diabetes arrives with vomiting and abdominal pain. Triage acuity is ESI 2; BP 94/58 mm Hg, HR 128/min, RR 30/min.

Question

A 23-year-old woman with type 1 diabetes arrives with vomiting and abdominal pain. Triage acuity is ESI 2; BP 94/58 mm Hg, HR 128/min, RR 30/min. Glucose is 486 mg/dL, pH 7.14, bicarbonate 9 mEq/L, anion gap 28, and potassium 5.2 mEq/L. Which of the following is the most appropriate next step in management?

Accepted Answer

Begin isotonic IV fluids and insulin infusion with potassium monitoring

Answer

Administer bicarbonate as routine first-line therapy

Answer

Give subcutaneous insulin and discharge

Answer

Withhold fluids until glucose normalizes

Answer

Give dextrose before any insulin because glucose is high

Diabetic ketoacidosis — ABEM Board MCQ