A 22-year-old man know case of T1DM run out of insulin dose and present to the ER with abdominal pain and altered mental status. The diagnosis is confirmed of DKA. They start IV fluid, insulin infusion and normalize electrolytes. After one day, his glucose drops to 190, bicarbonate is 20 and anion gab is 10. But patient has nausea last vomiting was 10 minutes ago. What is the next step in management?
سؤال مجاني 7 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. Continue insulin infusion until patient able orally intake
The labs show DKA has resolved: the anion gap is closed and bicarbonate has recovered. But the patient is still vomiting and cannot eat. Subcutaneous insulin starts only once the patient is eating again, and the IV infusion overlaps with it for 2–4 h. So for now, continue the insulin infusion (with dextrose) until oral intake is possible. Switching to home SC insulin while he is vomiting (A) is too early. Metformin/SGLT2 inhibitors are wrong for T1DM and SGLT2 inhibitors can cause euglycaemic DKA (C). An insulin pump (D) is not the acute next step.
- المصدر
- Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 17
- المحاضرة
- DKA & HHS · Endocrinology · Module B
- ظهر في
- MED43 ♀ Quiz B