A patient with type 1 diabetes mellitus presents with a blood glucose level >500 mg/dL. With DKA condition showing Acetonic breath and kussumul respiration. What is the most appropriate initial treatment?

1. A

   Administer insulin

2. B

   Provide IV fluid isotonic

3. C

   Administer Sodium bicarbonate

4. D

   Provide Potassium

Appeared in: NORCET 10 Prelims-2026

Explanation

Listen in Hindi

• Diabetic Ketoacidosis (DKA) causes severe dehydration due to osmotic diuresis from hyperglycemia.
• The first and most critical priority in DKA management is to restore intravascular volume and tissue perfusion.
• Administering isotonic IV fluids, such as 0.9% Normal Saline, accomplishes this by correcting hypovolemia and stabilizing the patient's hemodynamic status.
• Fluid resuscitation must begin before insulin therapy to prevent circulatory collapse and severe electrolyte shifts.

Why Other Options Were Wrong

• Option A: Administering insulin before correcting dehydration can worsen hypovolemia by causing a rapid fluid shift from the intravascular to the intracellular space, potentially leading to shock. It also drives potassium into cells, risking severe hypokalemia.
• Option C: Sodium bicarbonate is not used routinely in DKA management due to significant risks, including paradoxical central nervous system acidosis, cerebral edema, and hypokalemia.
• Option D: Although total body potassium is depleted in DKA, the initial serum potassium level can be normal or high due to the shift of potassium out of cells in an acidotic state. Giving potassium initially without knowing the serum level could lead to dangerous hyperkalemia.

Related Visual

• Visual 1: Flowchart - A flowchart illustrating the sequential steps of DKA management: 1. IV Fluids, 2. Check Potassium, 3. IV Insulin, 4. Monitor and Replace Electrolytes, 5. Add Dextrose when glucose falls. This visual helps reinforce the correct order of interventions.
• Visual 2: Diagram - A diagram showing the pathophysiology of DKA, illustrating how insulin deficiency leads to hyperglycemia, osmotic diuresis (dehydration), and ketogenesis (acidosis). This helps explain why fluid replacement is the top priority.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Initial management of Diabetic Ketoacidosis (DKA) to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the signs of DKA and initiating the correct treatment protocol promptly is a critical nursing responsibility that can be life-saving.
• The nurse's role includes rapid assessment, securing IV access, administering fluids as prescribed, and closely monitoring vital signs, fluid balance, and laboratory results (glucose, electrolytes, blood gases).
• What if? - If the patient's initial serum potassium level was low (e.g., less than 3.3 mEq/L), the protocol would change. In this case, potassium replacement must be started with the initial fluids, and insulin administration must be delayed until the potassium level is corrected to a safer range. Starting insulin would worsen the hypokalemia, risking cardiac arrhythmias.

How to Approach the Question

• First, identify the clinical condition from the key signs provided: very high blood glucose (>500 mg/dL), acetonic breath, and Kussmaul respirations clearly point to Diabetic Ketoacidosis (DKA).
• Next, recall the priorities for managing this medical emergency. The core principle is to address the most life-threatening problem first.
• In DKA, severe dehydration and circulatory collapse are the most immediate threats to life, even more so than the high blood sugar itself.
• Therefore, the management protocol prioritizes fluid resuscitation (Fluids) before correcting hyperglycemia (Insulin) and electrolyte imbalances.
• Evaluate the options based on this priority sequence: Isotonic IV fluid is the first step. Insulin, bicarbonate, and potassium are all subsequent or conditional interventions.
• Select the option that aligns with the initial, highest-priority action.

Concept Tested & Keywords

• Concept Tested: Initial management of Diabetic Ketoacidosis (DKA)
• Stem keywords: type 1 diabetes mellitus, blood glucose >500 mg/dL, DKA, Acetonic breath, Kussmaul respiration, initial treatment
• Lead-in keywords: most appropriate
• Clinical cues: The combination of very high blood glucose, acetonic breath (fruity smell), and Kussmaul respiration (deep, rapid breathing) is a classic triad for DKA, signaling a medical emergency.

Question ID

Qx--QNe9_vZWXG6eXHjUxg

Copy ID