A 55 year old diabetic man is brought to the emergency room in an unresponsive state. The following laboratory values are obtained: PCO2 19 mm Hg, HCO3 11 mEq/L, and pH 6.9. The most appropriate immediate treatment of this patient is ?
This patient is in a diabetic ketoacidotic coma. The goals in treating such a patient are to increase the rate of glucose utilization by insulin-dependent tissues, to reverse ketonemia and acidosis, and to replenish fluid imbalances. Oral hypoglycemic agents are commonly prescribed for the maintenance of NIDDM patients and would not be appropriate in an acute setting. Treatment with bicarbonate would result in only a transient elevation of pH. Since this is a life-threatening condition, monitoring the patient without treatment is unacceptable. Ref: D'Alessio D. (2011). Chapter 43. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia. In B.C. Knollmann (Ed), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.
Administration of an oral hypoglycemic agent
Administration of bicarbonate
Administration of insulin
Close observation only