Rajesh is known to have IDDM and he is brought to the emergency room in a coma due to diabetic ketoacidosis. Insulin therapy is begun without a delay. Which of the following should also accompany immediately?
Therapy of diabetic ketoacidosis requires more than insulin. Intravascular volume is often depleted, and initial fluids to restore volume should include isotonic saline or lactated Ringer's solution. If aerial blood pH is less than 7.1 or if severe hyperkalemia is present, bicarbonate supplementation should be used. IV fluids containing 5-10% dextrose (glucose) should be used when the serum glucose levels fall to 200-300 mg/dL, since high doses of rapidly acting insulin can cause life-threatening hypoglycemia. Additionally, the serum potassium concentration should be watched very carefully, since potassium is co transpoed into cells with glucose in the presence of insulin. It is often the case that hyperkalemia is present initially, secondary to decreased cellular uptake of potassium with decreased cellular uptake of glucose. However, this can rapidly change when insulin drives glucose (with potassium) into cells, and a life-threatening hypokalemia can develop. Supplementation with calcium is not required with insulin administration. Creatinine is a waste product, rather than a nutrient. Supplementation with magnesium is not required with insulin administration.
Calcium supplementation
Creatinine supplementation
Magnesium supplementation
Potassium supplementation