Answer and Explanation 5

5.   Choice B.  This patient is presenting with a clinical picture consistent with Diabetic Ketoacidosis (DKA).  Patients with DKA undergo an osmotic diuresis and present profoundly dehydrated.  Standard protocol dictates giving 2 liters of fluid to begin if they can tolerate it and starting the patient on an insulin drip.  The patients ABG’s demonstrate a metabolic acidosis.  Choice A is incorrect because the bicarb will correct itself when the acidosis resolves.  It is not advised in this situation.  Choice C is incorrect.  Hypertonic saline should almost never be given.  Correcting a “true” hypernatremia too quickly can result in pontine myelinolysis.  Choice D is simply not aggressive enough of management.  Patients with DKA need to be fluid rescuicitated more aggressively and need to have an insulin drip.