A 20-year-old female with a history of type 1diabetes and an eating disorder is found unconscious.In the emergency department,the following lab values are obtained: Glucose648 mg/dL
PH6) 88
PaCO₂20 mm Hg
PaO₂95 mm Hg
HCO_3-undetectable
Anion gap>31
Na⁺127 mEq/L
K⁺3.5 mEq/L
Creatinine1.8 mg/dL
After the patient's airway and ventilation have been established,the next priority for this patient is:

Question

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 prior to 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 20-Year-Old Female with a History of Type 1diabetes and an Eating