A 45 year old male known case of diabetes presents with nausea , multiple episodes of vomiting and abdominal pain.He is stuporous , having blood glucoselevel of 402 mg% and on urine examination Ketone bodies are detected.He is having tachycardina along with ohostatic hypotension. On lab investigation,his potassium levels are 3 meq/L.The next best step in the management will be:
This is a case of diabetic ketoacidosis (DKA)- Patient's serum K+ level is< 3.3 meq/L,In such cases K+ Level need to be corrected first, even before administering insulin. So next best steps in the management of this patient include: Correct hypokalemia-Repeat K+levels in serum-Give IV regular insulin after K+ level is> 3.3 meq/L Even during the treatment with insulin and fluids, Hypokalemia worsens because of: Insulin mediated potassium entry into cells Settlement of acidosis K+ loss in urine Therefore if we won't correct hypokalemia (<3.3 meq/L) in case of DKA, it will aggravate with the insulin and fluids if given initially. Note-Nausea and severe vomiting are due to the ketonemia which trigger vomiting center- CTZ
Manage hypokalemia-Repeat serum K+ levels- IV fluids and sta IV regular insulin
IV fluids-give IV regular insulin and lastly manage hypokalemia
Give IV regular insulin along with K+ - IV fluids after the K+ level is normal
IV fluids - give Lente insulin and side by side manage hypokalemia
Diabetes Mellitus