Diabetic emergencies: practice question

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

The answer and the reasoning

C. Give fluids and potassium replacement first; delay insulin until potassium is above the safe threshold

Insulin drives potassium into cells, so starting it with a low serum potassium can cause fatal arrhythmias. Total body potassium is depleted in DKA even when serum level is normal or high. Protocols therefore replace potassium and fluids first when it is low, and start insulin only once it is safely above the threshold.

Option by option

• A. Give sodium bicarbonate bolus before any other treatment

  Bicarbonate is reserved for very severe acidosis and does not replace correcting potassium and volume.

• B. Start an intravenous insulin infusion immediately and add potassium later

  Immediate insulin with a potassium of 2.9 risks severe hypokalaemia and cardiac arrest.

• C. Give fluids and potassium replacement first; delay insulin until potassium is above the safe threshold (correct)

  Correct. Correcting hypokalaemia first prevents insulin-induced arrhythmia and respiratory muscle weakness.

• D. Give subcutaneous long-acting insulin alone and review in the morning

  Subcutaneous basal insulin alone is inadequate to resolve ketoacidosis in a severely ill patient.

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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