A patient with a history of type 1 diabetes and an eating disorder is found unconscious.In the emergency department,the following lab values are obtained: Glucose: 648 mg/dL PH: 6.88 P_aCO₂: 20 mm Hg P_aO₂: 95 mm Hg HCO₃-: undetectable Anion gap: 31 Na⁺: 127 mEq/L K⁺: 3.5 mEq/L Creatinine: 1.8 mg/dL After the patient's airway and ventilation have been established,the next priority for this patient is: A) administration of a 1-L normal saline fluid bolus. B) administration of 0.1 unit of regular insulin IV push followed by an insulin infusion. C) administration of 20 mEq KCl in 100 mL. D) IV push administration of 1 amp of sodium bicarbonate.

Question

A patient with a history of type 1 diabetes and an eating disorder is found unconscious.In the emergency department,the following lab values are obtained: Glucose: 648 mg/dL PH: 6.88 P_aCO₂: 20 mm Hg P_aO₂: 95 mm Hg HCO₃-: undetectable Anion gap: >31 Na⁺: 127 mEq/L K⁺: 3.5 mEq/L Creatinine: 1.8 mg/dL After the patient's airway and ventilation have been established,the next priority for this patient is: A) administration of a 1-L normal saline fluid bolus. B) administration of 0.1 unit of regular insulin IV push followed by an insulin infusion. C) administration of 20 mEq KCl in 100 mL. D) IV push administration of 1 amp of sodium bicarbonate.

Quizplus · Accepted Answer

After airway is established,the next priority in management of DKA is fluid resuscitation with 1 liter of normal saline over 1 hour.The fluid resuscitation should begin before administration of insulin.Potassium may be added to fluid replacement bags after the first liter of normal saline has infused,provided that the serum potassium is greater than 3.3 mEq/L.Although bicarbonate replacement is indicated in this clinical situation,the bicarbonate is administered by infusion,not by IV push,until the pH exceeds 7.0.

A Patient with a History of Type 1 Diabetes and an Eating