A 19-year-old man with type 1 diabetes has abdominal pain, vomiting, and Kussmaul respirations. Glucose is 540 mg/dL, pH is 7.12, bicarbonate is 9

Question

A 19-year-old man with type 1 diabetes has abdominal pain, vomiting, and Kussmaul respirations. Glucose is 540 mg/dL, pH is 7.12, bicarbonate is 9 mEq/L, potassium is 5.2 mEq/L, and serum ketones are positive. Which of the following is the most appropriate next step in management?

Accepted Answer

Intravenous fluids and insulin infusion with potassium monitoring

Answer

Fluid restriction

Answer

Oral metformin

Answer

Sodium bicarbonate for every patient at this pH

Answer

Subcutaneous long-acting insulin alone and discharge

Diabetic ketoacidosis — USMLE Step 3 MCQ

A 19-year-old man with type 1 diabetes has abdominal pain, vomiting, and Kussmaul respirations. Glucose is 540 mg/dL, pH is 7.12, bicarbonate is 9 mEq/L, potassium is 5.2 mEq/L, and serum ketones are positive. Which of the following is the most appropriate next step in management?