A patient with diabetes mellitus has a blood glucose level of 644 mg/dl. The management of this patient would include all of the following EXCEPT?

1. A

   IV Fluids

2. B

   IV Insulin Infusion

3. C

   Correction of metabolic acidosis

4. D

   IV Corticosteroid

Appeared in: RML Lucknow - 2021

Explanation

• IV Corticosteroids are the correct answer because they are contraindicated in the management of severe hyperglycemia.
• Corticosteroids are known to increase blood glucose levels by stimulating glucose production in the liver (gluconeogenesis) and increasing insulin resistance.
• Administering a corticosteroid would worsen the patient's already critical hyperglycemic state, directly opposing the treatment goals.
• Illness and stress can naturally raise cortisol levels, which is often a precipitating factor for DKA/HHS; therefore, adding more via IV would be harmful.

Why Other Options Were Wrong

• Option A: This is a cornerstone of DKA/HHS management. Severe hyperglycemia causes osmotic diuresis, leading to profound dehydration and electrolyte loss that must be corrected urgently.
• Option B: This is a critical intervention. A continuous IV infusion of regular insulin is necessary to lower blood glucose, halt ketone production, and resolve acidosis.
• Option C: This is a primary goal of treatment, especially in DKA. The metabolic acidosis is corrected by stopping ketone production with insulin and restoring volume with IV fluids.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of Hyperglycemic Emergencies to guide bedside assessment, documentation, and the next nursing action.
• A nurse's priority in a hyperglycemic crisis is to initiate prescribed IV fluids and insulin, followed by meticulous monitoring.
• Hourly blood glucose monitoring is essential to guide insulin therapy and prevent a rapid drop in glucose, which can cause cerebral edema.
• Potassium levels must be checked before starting insulin. If hypokalemia is present, potassium must be replaced first to prevent life-threatening cardiac arrhythmias.

How to Approach the Question

• First, identify the key information in the stem: a patient with diabetes has a blood glucose of 644 mg/dL. This is a hyperglycemic emergency.
• Note that the question uses the word 'EXCEPT'. This means you are looking for the option that is NOT a correct treatment.
• Evaluate each option based on standard protocols for managing DKA or HHS.
• Option A (IV Fluids): This is a primary treatment for dehydration in DKA/HHS. So, it's a correct treatment.
• Option B (IV Insulin): This is essential to lower glucose and stop ketosis. So, it's a correct treatment.
• Option C (Correction of acidosis): This is a key goal in DKA management. So, it's a correct treatment.

Concept Tested & Keywords

• Concept Tested: Management of Hyperglycemic Emergencies
• Stem keywords: diabetes mellitus, blood glucose level 644 mg/dl, management
• Lead-in keywords: EXCEPT
• Clinical cues: Blood glucose of 644 mg/dl signifies a medical emergency (DKA or HHS).
• Negative lead-in flag: Question asks for the exception in management.

Question ID

Q0Sa-VeO44oDqOjA9ZO5zn

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1332-1334

E6 Medicine Harrison 22e Part 2 p. 1123-1125