Question

A 20-year-old female with a history of type 1 diabetes and an eating disorder is found unconscious. In the emergency department, the following lab values are obtained:

Glucose: 648 mg/dL
pH: 6.88
PaCO₂: 20 mm Hg
PaO₂: 95 mm Hg
HCO₃-: undetectable
Anion gap: >31
Na⁺: 127 mEq/L
K⁺: 3.5 mEq/L
Creatinine: 1.8 mg/dL

After the patient's airway and ventilation have been established, the next priority for this patient is:
1) administration of a 1-L normal saline fluid bolus.
2) administration of 0.1 unit of regular insulin IV push followed by an insulin infusion.
3) administration of 20 mEq KCl in 100 mL.
4) IV push administration of 1 amp of sodium bicarbonate.

Answer 1

The next priority for the unconscious 20-year-old female with a history of type 1 diabetes and an eating disorder is the administration of insulin.

Step-by-step explanation:

The next priority for the unconscious 20-year-old female with a history of type 1 diabetes and an eating disorder is the administration of 0.1 unit of regular insulin IV push followed by an insulin infusion (option 2). In this case, the lab values indicate diabetic ketoacidosis (DKA) which is a life-threatening condition. The high glucose level, low pH, low HCO₃-, and high anion gap suggest that the patient is in DKA. Insulin administration is crucial to correct the underlying problem of relative insulin deficiency and hyperglycemia in DKA.