A 72-year-old with HHS has received initial isotonic fluid. Glucose is 780 mg/dL, effective osmolality 348 mOsm/kg, pH 7.34, bicarbonate 20 mEq/L,

Question

A 72-year-old with HHS has received initial isotonic fluid. Glucose is 780 mg/dL, effective osmolality 348 mOsm/kg, pH 7.34, bicarbonate 20 mEq/L, beta-hydroxybutyrate 1.2 mmol/L, and potassium 4.4 mEq/L. What insulin regimen is appropriate?

Accepted Answer

Begin intravenous regular insulin at 0.05 units/kg/hour without a loading bolus

Answer

Give an intravenous insulin bolus and continue at 0.10 units/kg/hour

Answer

Give subcutaneous rapid-acting insulin every two hours during fluid replacement

Answer

Begin intravenous regular insulin at 0.10 units/kg/hour without a loading bolus

Answer

Begin intravenous regular insulin at 0.025 units/kg/hour without a loading bolus

Insulin intensification — USMLE Step 3 MCQ

A 72-year-old with HHS has received initial isotonic fluid. Glucose is 780 mg/dL, effective osmolality 348 mOsm/kg, pH 7.34, bicarbonate 20 mEq/L, beta-hydroxybutyrate 1.2 mmol/L, and potassium 4.4 mEq/L. What insulin regimen is appropriate?