A 27-year-old man with type 1 diabetes mellitus that was diagnosed 15 years ago comes to the emergency department due to abdominal pain, nausea, and vomiting. He stopped taking his insulin for the last 2 days due to not feeling well and inability to eat. His temperature is 36 C. blood pressure 102/60 mmHg, pulse is 110 bpm, and respiratory rate is 26 bpm. The patient appears lethargic and dehydrated. Laboratory results are as follows: Sodium: 128 mEq/L (normal 136 - 146 mEq/L) Potassium: 5.4 mEq/L (normal 3.5 - 5.0 mEq/L) Chloride: 90 mEq/L (normal 95 - 105 mEq/L) Bicarbonate: 10 mEq/L (normal 22 - 28 mEq/L) Blood glucose: 550 mg/dL (normal random < 140 mg/dL) Which of the following is the most appropriate next step in management of this patient?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Normal saline and regular insulin infusion
This is DKA (glucose 550, HCO3 10, anion gap 28, missed insulin). Management starts with isotonic (0.9%) saline to restore volume, then a low-dose IV regular insulin infusion. Insulin can start because K+ is ≥3.3 (5.4 here). SC home insulin or NPH (A, B) is not used for initial DKA treatment, hypertonic saline is not indicated, and 0.45% saline is not the initial resuscitation fluid in the lecture.
ليش كل خيار صح أو غلط
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A
ليش غلط
DKA is treated with low-dose IV insulin once K+ is at least 3.3 (his is 5.4), not by simply resuming the home subcutaneous regimen.
✓ RT - DM.pdf · p. 20 -
B
ليش غلط
Dextrose is added to the saline when glucose falls to 200 mg/dL; his glucose is 550, so fluids start as isotonic saline without dextrose.
✓ RT - DM.pdf · p. 21 -
C
ليش غلط
The lecture starts DKA fluids with isotonic (0.9%) saline, not hypertonic saline.
✓ RT - DM.pdf · p. 21 -
D
ليش صح
DKA treatment starts with isotonic saline to restore volume, then low-dose IV insulin, which is safe because K+ (5.4) is at least 3.3.
✓ RT - DM.pdf · p. 20 -
E
ليش غلط
The fluid named in the lecture is isotonic (0.9%) saline; half-normal (0.45%) saline is not the DKA starting fluid.
✓ RT - DM.pdf · p. 21
- المصدر
- RT - DM.pdf · p. 21
RT - DM.pdf · p. 20 - المحاضرة
- DKA & HHS · Endocrinology · Module B
- ظهر في
- Endo bank