A patient with type 2 diabetes is obtunded, profoundly dehydrated, glucose 48 mmol/L, measured osmolality 345 mOsm/kg, pH 7.36 and minimal ketones.

Question

A patient with type 2 diabetes is obtunded, profoundly dehydrated, glucose 48 mmol/L, measured osmolality 345 mOsm/kg, pH 7.36 and minimal ketones. What is the initial treatment priority?

Accepted Answer

Start isotonic fluids with electrolyte and osmolality monitoring

Answer

Give bicarbonate because glucose is markedly elevated

Answer

Use fluid restriction to prevent cerebral edema

Answer

Start a large insulin bolus before restoring intravascular volume

Answer

Treat with oral glucose and discharge after mental status improves

Suspected lupus nephritis — RCPSC IM MCQ

A patient with type 2 diabetes is obtunded, profoundly dehydrated, glucose 48 mmol/L, measured osmolality 345 mOsm/kg, pH 7.36 and minimal ketones. What is the initial treatment priority?