Question

A patient with diabetes mellitus for the past 5 years presents with vomiting and abdominal pain. She is non-compliant with medication and appears dehydrated. Investigations revealed a blood sugar value of 500 mg/dl and the presence of ketone bodies. What is the next best step in management?

• A. Intravenous fluids with long-acting insulin
• B. Intravenous fluids
• C. Intravenous insulin
• D. Intravenous fluids with regular insulin

Answer 1

The Correct Option is D

This scenario involves a patient with diabetes mellitus displaying symptoms of vomiting, abdominal pain, non-compliance with medication, dehydration, hyperglycemia (blood sugar of 500 mg/dL), and ketonemia. These symptoms are indicative of diabetic ketoacidosis (DKA), a serious complication that needs urgent treatment.

The primary goals in managing DKA include the following:

1. Rehydration
2. Correction of hyperglycemia
3. Reversal of ketosis

First, rehydration is crucial. Dehydration is evident, so intravenous fluids are required immediately. Generally, isotonic saline (0.9% NaCl) is used initially to restore circulatory volume.

Second, insulin therapy is essential to reduce blood glucose levels and address ketogenesis. Regular insulin is typically administered intravenously due to its rapid action.

Given these considerations, the most appropriate management step for this patient, combining rehydration with insulin therapy to tackle both dehydration and uncontrolled blood sugar, is:

Intravenous fluids with regular insulin

This approach will provide both immediate volume resuscitation and insulin delivery to decrease blood glucose and ketoacid levels.