A 19-year-old man with type 1 diabetes presents with vomiting, abdominal pain and thirst after missing insulin. He is drowsy, respiratory rate is

Question

A 19-year-old man with type 1 diabetes presents with vomiting, abdominal pain and thirst after missing insulin. He is drowsy, respiratory rate is 28/min, glucose is 28 mmol/L, venous pH is 7.12, bicarbonate is 9 mmol/L, and ketones are positive. What is the most appropriate next step in management?

Accepted Answer

Start intravenous isotonic fluids and fixed-rate insulin with potassium monitoring

Answer

Start oral rehydration and withhold insulin overnight

Answer

Restrict fluids until serum sodium normalises

Answer

Give bicarbonate as first-line therapy for every case

Answer

Give subcutaneous rapid-acting insulin and discharge when eating

Diabetic ketoacidosis — MCCQE Part 1 MCQ

A 19-year-old man with type 1 diabetes presents with vomiting, abdominal pain and thirst after missing insulin. He is drowsy, respiratory rate is 28/min, glucose is 28 mmol/L, venous pH is 7.12, bicarbonate is 9 mmol/L, and ketones are positive. What is the most appropriate next step in management?