A 17-year-old young man, has T1DM for 9 years, has progressive abdominal pain, nausea, vomiting, and fever for 3 days. He was not compliant to insulin given his poor oral intake and his fear of hypoglycemia. On examination, he has altered level of consciousness, HR 110/min, BP 95/65mmHg, and Temp 37.9°C. His abdomen is diffusely tender. Dry mucous membranes. Unremarkable cardiovascular and chest examination. His investigations show random blood glucose 450mg/dl, sodium 132mEg/L, potassium 3.0mEq/L, and creatinine 1.0mg/dl. His ABG show arterial pH 7.1, PCO2 28, and HCO3 13. Which of the following is the most appropriate step in treating this patient?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: B. A bolus of 1L normal saline with potassium chloride 40mEg/hour
- إجابة ثانية: A. A bolus of 1L normal saline
This is DKA with K 3.0 mEq/L. When K is below 3.3, hold insulin and give potassium (20–40 mEq/hr) with the IV fluids until K is above 3.3, so saline plus KCl is the best fit. Any option that gives insulin now (C, D) risks dangerous hypokalaemia. The old bank chose saline alone (A), because the lecture slide calls isotonic saline the 'first step'. But the same slide says the potassium deficit is corrected next and should guide the choice of fluid, and another student bank keys B.
ليش كل خيار صح أو غلط
-
A
ليش صح
Supported by the RT slides: the first step in DKA is isotonic saline; the same slide says potassium is corrected next. (Step Up supports B.)
✓ RT - DM.pdf · p. 20 -
B
ليش صح
Supported by Step Up: with K below 3.3, hold insulin and give potassium with the IV fluids until K is above 3.3; here K is 3.0. (The RT slide supports A.)
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 17 -
C
ليش غلط
Insulin is held when K is below 3.3 (here 3.0), so giving 10 units of regular insulin now is unsafe.
✓ Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 17 -
D
ليش غلط
Insulin therapy should be delayed until potassium replacement has begun when K is below 3.3; this option gives insulin first.
✓ RT - DM.pdf · p. 20
- المصدر
- Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 17
RT - DM.pdf · p. 20 - المحاضرة
- DKA & HHS · Endocrinology · Module B
- ظهر في
- Endo bank