skip to main content

Diabetic ketoacidosis — SCE Acute Medicine MCQ

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

EasyAcute Renal and Metabolic EmergenciesDiabetic ketoacidosisSCE Acute Medicine

A 22-year-old woman with type 1 diabetes presents with vomiting and abdominal pain after missing insulin. Glucose is 28 mmol/L, capillary ketones 5.6 mmol/L, pH 7.12, bicarbonate 8 mmol/L and potassium 5.4 mmol/L. She is tachycardic but BP is 112/70 mmHg. 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: C — Start fixed-rate intravenous insulin with intravenous fluids and potassium-guided monitoring

This is diabetic ketoacidosis requiring fixed-rate IV insulin, fluid replacement and careful potassium monitoring. Potassium is initially high from acidosis but total body potassium is depleted, so replacement decisions must follow serial levels. Bicarbonate is not routine and can cause harm except in extreme circumstances. The endpoint is ketone clearance, not simply normalisation of glucose.

Reference: JBDS DKA guideline 2023, BNF