Question

A 15-year-old adolescent with known type 1 diabetes mellitus presents with fatigue, vomiting and diarrhea. Random blood glucose is 700 mg/dL, serum sodium is 125 mEq/L, and potassium is 4.2 mEq/L. Which of the following is not recommended during initial management?

• A. Administration of 3% saline
• B. Initiation of 0.9% normal saline infusion
• C. Intravenous insulin therapy
• D. Frequent monitoring of serum potassium levels

Hint:

DKA initial management: normal saline, insulin and potassium monitoring. Hypertonic saline is not routine.

Answer 1

The Correct Option is A

Concept: This presentation suggests diabetic ketoacidosis or severe hyperglycemic crisis. Initial management includes isotonic saline, insulin and electrolyte monitoring.

Step 1: Identify emergency.
Type 1 diabetes with glucose: \[ 700\ \text{mg/dL} \] and vomiting suggests diabetic ketoacidosis.

Step 2: Recall initial management.
Initial management includes: \[ 0.9% \text{ normal saline} + \text{IV insulin} + \text{potassium monitoring} \]

Step 3: Identify not recommended option.
Routine administration of hypertonic saline is not recommended initially. Therefore, the answer is: \[ 3% \text{ saline} \]