Your patient is a 68-year-old female who has been in a rehabilitation hospital for one week following hip replacement surgery. According to the staff, the patient is a type II diabetic and is being treated for a postoperative infection. The patient was lethargic yesterday and was found unresponsive this morning, just before your arrival. Physical exam reveals an accumulation of secretions in her airway, lung sounds clear and equal bilaterally, and skin and mucous membranes warm and dry. HR = 119, BP = 86/58, RR = 16, blood glucose = 864 mg/dL. In addition to initiating basic airway management measures and gaining IV access, which of the following is the best treatment for this patient?

Question

Quizplus · Accepted Answer

The patient is likely experiencing diabetic ketoacidosis (DKA) given the high blood glucose level (864 mg/dL) and the clinical presentation (lethargy, unresponsiveness, and hypotension). The best treatment for DKA includes fluid resuscitation with normal saline (NS) to address dehydration and hypotension, and airway management if necessary due to altered mental status. Intubation may be required for airway protection in an unresponsive patient. Dextrose (choice A) is contraindicated due to the already high blood glucose. Sodium bicarbonate (choice B) is not routinely recommended in DKA treatment without severe acidosis, and the patient's acid-base status is not provided. BVM ventilations with supplemental oxygen (choice C) may be necessary if the patient is not breathing adequately, but this choice lacks the necessary fluid resuscitation.

Your Patient Is a 68-Year-Old Female Who Has Been in a Rehabilitation