A 78-year-old woman with type 2 diabetes presents with drowsiness after 5 days of infection. Glucose is 44 mmol/L, serum osmolality 338 mOsm/kg, pH

Question

A 78-year-old woman with type 2 diabetes presents with drowsiness after 5 days of infection. Glucose is 44 mmol/L, serum osmolality 338 mOsm/kg, pH 7.36, ketones 0.3 mmol/L and sodium is 158 mmol/L corrected for glucose. What is the most appropriate initial management?

Accepted Answer

Slow intravenous 0.9% sodium chloride rehydration with careful osmolality monitoring

Answer

Rapid correction with 0.45% sodium chloride

Answer

Subcutaneous semaglutide initiation

Answer

Fixed-rate insulin before fluids

Answer

Intravenous bicarbonate infusion

Hyperosmolar hyperglycaemic state — SCE Endocrinology MCQ

A 78-year-old woman with type 2 diabetes presents with drowsiness after 5 days of infection. Glucose is 44 mmol/L, serum osmolality 338 mOsm/kg, pH 7.36, ketones 0.3 mmol/L and sodium is 158 mmol/L corrected for glucose. What is the most appropriate initial management?