A 24-year-old woman with type 1 diabetes presents with vomiting and abdominal pain after missed insulin. Glucose is 28 mmol/L, ketones 6.1 mmol/L, pH

Question

A 24-year-old woman with type 1 diabetes presents with vomiting and abdominal pain after missed insulin. Glucose is 28 mmol/L, ketones 6.1 mmol/L, pH 7.18, bicarbonate 9 mmol/L and potassium 3.2 mmol/L. She is dehydrated but alert. What is the most appropriate next step in management?

Accepted Answer

Start intravenous fluids and potassium replacement before fixed-rate insulin infusion

Answer

Restrict fluids until glucose falls below 15 mmol/L

Answer

Give subcutaneous rapid-acting insulin and discharge after eating

Answer

Give bicarbonate routinely because pH is below 7.20

Answer

Start fixed-rate insulin immediately without potassium

Diabetic ketoacidosis with hypokalaemia — SCE Acute Medicine MCQ

A 24-year-old woman with type 1 diabetes presents with vomiting and abdominal pain after missed insulin. Glucose is 28 mmol/L, ketones 6.1 mmol/L, pH 7.18, bicarbonate 9 mmol/L and potassium 3.2 mmol/L. She is dehydrated but alert. What is the most appropriate next step in management?