Answer 1 is incorrect. 13% chose this answer. “Give another 2 liters of NS with 20 meq/L of KCL.”  Since KT has already received 2 liters of normal saline for fluid resuscitation, the next step is to provide a solution with glucose, and possibly potassium depending on KT’s electrolyte levels. Even with euglycemic DKA, KT has depleted their glycogen stores and the cells are in desperate need of glucose for two reasons; to stop burning fat for fuel and to replete glycogen stores.

Answer 2 is incorrect. 13.42% of you chose this answer. “Continue current therapy.”  While this answer is tempting, it does not provide a clear plan of action for KT.  The only therapy this is currently being provided is an IV of normal saline. Even though KT’s blood glucose is less than 200mg/dL, in order to stop ketosis, we need to start IV insulin along with 5-10% dextrose to preserve blood glucose and replace glycogen stores.

Answer 3 is correct. About 55.20% of respondents chose this. “Start insulin infusion with a dextrose-based solution.”  YES!  This is the best answer. The next step is to provide an IV solution with 5-10% glucose, and possibly potassium depending on KT’s electrolyte levels. Even with euglycemic DKA, KT has depleted their glycogen stores and the cells are in desperate need of glucose for two reasons; to stop burning fat for fuel and to replete glycogen stores. In addition, in order to stop ketosis, we need to start IV insulin at a few units an hour!

Finally, Answer 4 is incorrect. 18.29% chose this answer. “Give an amp of sodium bicarbonate.” Since KT is in acidosis, this is a tempting answer.  However, the acidosis will usually be corrected with administration of IV fluids and insulin. If not, and the pH is still below 7.0, bicarb administration may be considered.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!