Critical care: diabetic ketoacidosis management: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Critical care: diabetic ketoacidosis management

Sample item

A patient with DKA has a glucose of 520 mg/dL, pH 7.05 and potassium of 2.9 mmol/L. What is the next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Give fluids and potassium replacement before starting insulin

Insulin drives potassium into cells, and starting it with a potassium below 3.3 mmol/L can cause fatal arrhythmia. Fluid resuscitation and potassium replacement come first, and insulin starts once potassium is above 3.3. Bicarbonate is used only for very severe acidosis.

Option by option

  • A. Give 50 percent dextrose

    Dextrose is added later, when glucose falls to about 200 to 250 mg/dL.

  • B. Give fluids and potassium replacement before starting insulin (correct)

    Correct. Potassium must be corrected before insulin.

  • C. Give sodium bicarbonate bolus

    Bicarbonate is not the first step.

  • D. Start insulin infusion immediately

    Insulin now would worsen hypokalaemia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, Give fluids and potassium replacement before starting insulin. Insulin drives potassium into cells, and starting it with a potassium below 3.

Why is "Give 50 percent dextrose" not the answer?

Dextrose is added later, when glucose falls to about 200 to 250 mg/dL.

Why is "Give sodium bicarbonate bolus" not the answer?

Bicarbonate is not the first step.

Why is "Start insulin infusion immediately" not the answer?

Insulin now would worsen hypokalaemia.

What concept does this question test?

It tests Critical care: diabetic ketoacidosis management in Anaesthesia. 3 mmol/L can cause fatal arrhythmia. Fluid resuscitation and potassium replacement come first, and insulin starts once potassium is above 3.3. Bicarbonate is used only for very severe acidosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Critical care: diabetic ketoacidosis management?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.