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Diabetic ketoacidosis — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesDiabetic ketoacidosisSCE Acute Medicine

A 24-year-old woman is assessed on the acute medical unit. She has type 1 diabetes, vomiting and abdominal pain. Glucose is 28 mmol/L, ketones 6.0 mmol/L, pH 7.18 and bicarbonate 10 mmol/L. Initial assessment includes relevant observations, bedside tests and urgent blood results. 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: B — Commence fixed-rate intravenous insulin infusion

Commence fixed-rate intravenous insulin infusion is the best answer because DKA requires fixed-rate insulin with fluids and potassium monitoring according to UK protocol. Give isotonic crystalloid boluses with frequent reassessment is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Do not stop basal insulin during DKA unless specifically contraindicated.

Reference: JBDS DKA guideline; BNF