skip to main content

Severe diabetic ketoacidosis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardDiabetes and endocrine medicineSevere diabetic ketoacidosisSCE Acute Medicine

A 49-year-old woman with long-standing type 1 diabetes is found unconscious at home after vomiting for two days. Glucose is 34 mmol/L, pH 6.98, bicarbonate 5 mmol/L, potassium 5.9 mmol/L and ketones 7.5 mmol/L. GCS is 8 and she is hypotensive despite initial fluids. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Manage DKA with fixed-rate insulin and fluids while escalating to critical care because of reduced consciousness and shock

This is severe DKA with profound acidosis, shock and reduced consciousness, requiring standard DKA therapy plus critical care escalation. Fixed-rate IV insulin and fluid resuscitation are central, with potassium monitored closely as treatment proceeds. Bicarbonate is not routine and is reserved for exceptional severe acidotic compromise with specialist input.

Reference: JBDS DKA Guideline 2023