Internal Medicine Diabetic Ketoacidosis Management Questions and Answers

Question 1

A 24-year-old female with type 1 diabetes presents to the emergency department with nausea, vomiting, and abdominal pain.
Her labs show a blood glucose of 450 mg/dL, pH of 7.15, bicarbonate of 10 mEq/L, and positive serum ketones.
Her initial serum potassium is 3.1 mEq/L.
After initiating intravenous fluid resuscitation with 0.9% normal saline, what is the most appropriate next step in management?

Accepted Answer

Administer intravenous potassium chloride before starting an insulin infusion.

Answer

Administer a 0.1 unit/kg IV bolus of regular insulin immediately.

Answer

Start a continuous IV insulin infusion at 0.1 units/kg/hour.

Answer

Administer sodium bicarbonate to correct the acidosis.

Question 2

A 45-year-old male is being treated for moderate Diabetic Ketoacidosis. His initial blood glucose was 520 mg/dL. He has received several hours of IV fluids and a continuous insulin infusion. His current blood glucose is 190 mg/dL, but his anion gap remains elevated at 18 mEq/L and his serum bicarbonate is 14 mEq/L. Which of the following is the most appropriate adjustment to his management?

Accepted Answer

Add dextrose to the intravenous fluids and continue the insulin infusion.

Answer

Decrease the insulin infusion rate by half.

Answer

Change the intravenous fluids to 0.45% NaCl without dextrose.

Answer

Discontinue the insulin infusion and switch to subcutaneous insulin.

Question 3

Which of the following sets of criteria best indicates the resolution of Diabetic Ketoacidosis and readiness to transition from an intravenous insulin infusion to a subcutaneous regimen?

Accepted Answer

Blood glucose < 200 mg/dL, serum bicarbonate ≥ 15 mEq/L, and anion gap ≤ 12 mEq/L

Answer

Blood glucose < 250 mg/dL and venous pH > 7.25

Answer

Blood glucose < 180 mg/dL and anion gap < 16 mEq/L

Answer

Urine ketones are negative and serum bicarbonate > 20 mEq/L

Question 4

A 33-year-old patient with type 1 diabetes is admitted with severe DKA. Initial management includes aggressive IV fluid resuscitation and a continuous regular insulin infusion. According to current guidelines, what is the recommended initial rate for the insulin infusion in most adult patients?

Accepted Answer

0.1 units/kg/hour, with or without an initial bolus

Answer

0.05 units/kg/hour without a bolus

Answer

0.2 units/kg/hour without a bolus

Answer

A fixed rate of 20 units/hour until blood glucose is <300 mg/dL

Question 5

A 58-year-old female is being treated for DKA. After 12 hours of treatment, her anion gap has closed, her pH is 7.32, and her blood glucose is 175 mg/dL. She is awake, alert, and hungry. The decision is made to transition her to subcutaneous insulin. What is the correct procedure to ensure a safe transition?

Accepted Answer

Administer the first dose of subcutaneous long-acting insulin and continue the IV insulin infusion for 1-2 hours.

Answer

Stop the IV insulin infusion and immediately administer the first dose of subcutaneous long-acting insulin.

Answer

Administer the first dose of subcutaneous rapid-acting insulin and stop the IV insulin infusion 30 minutes later.

Answer

Stop the IV insulin infusion for 4 hours, then begin the patient's home subcutaneous insulin regimen.

Question 6

A 29-year-old male presents with DKA precipitated by an infection. His initial labs include a pH of 6.95, bicarbonate of 6 mEq/L, and potassium of 5.8 mEq/L. He is hemodynamically stable. In addition to IV fluids and insulin, which of the following interventions is most appropriate regarding his severe acidemia?

Accepted Answer

Routine use of sodium bicarbonate is not recommended.

Answer

Administer 50 mEq of sodium bicarbonate IV over 30 minutes.

Answer

Initiate continuous renal replacement therapy (CRRT).

Answer

Withhold insulin until the pH is > 7.1.