Question

A 30-year-old female with type 1 diabetes mellitus presents to the emergency department with nausea, vomiting, abdominal pain, and polyuria. On examination, she is tachycardic, hypotensive, and has Kussmaul respirations. Her initial laboratory results are as follows: Blood glucose: 600 mg/dL Arterial blood gas (ABG): pH 7.1, HCO3- 10 mmol/L, pCO2 25 mmHg Serum potassium: 4.8 mmol/L Serum sodium: 130 mmol/L Serum ketones: positive Anion gap: 28 Which of the following is the correct initial management strategy for this patient?

Select 1 answer (1 correct choice).

Choice A

Administer a bolus of sodium bicarbonate to correct metabolic acidosis

Choice B

Start a continuous infusion of insulin at 0.1 units/kg/hr without a bolus

Choice C

Administer a bolus of insulin at 0.1 units/kg

Choice D

Delay insulin therapy until serum potassium is less than 3.3 mmol/L

Choice E

Initiate dextrose 5% infusion immediately to prevent hypoglycemia

Selected 0 of 1