E2 DKA quiz

1. Ms. Y a 25 year old female, presented to the Emergency department with reduced consciousness (Coma like state). Upon examination she was diagnosed to be in shock. Choose the correct sequence of emergency management for this patient.

• Resuscitation, IV fluid therapy, IV insulin therapy 

• IV insulin therapy, Resuscitation, IV fluid therapy 

• IV fluid therapy, IV Insulin therapy, Resuscitation 

• IV fluid therapy, Resuscitation, IV insulin therapy

2. Mr. O,  an 18 year old male, who came to the  Emergency department with shock, was initially resuscitated and given IV fluids along with Insulin. But he was still in shock and symptoms were not improved. What is your next step of management?

• Give mannitol 0.5 - 1 g/kg or hypertonic solution

• Re-evaluate and Repeat the above procedure of Resuscitation 

• Transition to SC insulin therapy 

• Add 5% dextrose in the infusate  and adjust type of IV fluid based on serum sodium concentration after 4 - 6 hours

3. Mr. B is a 26 year old male, he came to the hospital with abdominal pain and vomiting. Upon examination, he was hyperventilating and showed some signs of dehydration. He was not in shock and was fully conscious. Which of the following is the most appropriate step to manage Mr. B?

• IV fluid therapy, electrocardiography (ECG), potassium therapy

• IV fluid therapy, IV insulin infusion

• Nasogastric tube insertion, saline infusion 

• Wait and observe 

4. Mr. D was a 25 year old, he came to the hospital with abdominal pain and vomiting. He is diagnosed by a physician with diabetic ketoacidosis (DKA). IV fluid therapy was given to him, what would be the next appropriate step?

• IV insulin infusion with dosage of 0.1 - 0.2 unit/kg/hour 

• Subcutaneous insulin 

• Oral insulin 

• IV insulin infusion  with dosage of 0.05 - 0.1 unit/kg/hour

5. Ms. V is a 19 year old female, she came with complaints of mild abdominal pain and vomiting. Upon examination, she showed minimal signs of dehydration and she is tolerating oral fluid. Which of the following should be the next step of management for Ms. V?

• Resuscitation

• IV fluid therapy, electrocardiography (ECG), potassium therapy 

• Subcutaneous insulin, oral hydration 

• IV insulin, saline infusion

6. Mr. J is a 24 year old male, he came to the hospital due to vomiting and mild abdominal pain, he was diagnosed with diabetic ketoacidosis (DKA) by a physician and subcutaneous insulin and oral hydration was initiated but he showed no signs of improvement. What would be the next step of management for Mr. J?

• Resuscitation

• Increase dosage of subcutaneous insulin, IV fluid therapy 

• IV fluid therapy, electrocardiography (ECG), potassium therapy

• Nasogastric tube insertion, potassium therapy

7. Mr. A, a 35 year old male was brought to the Emergency department with complaints of Vomiting and hyperventilation by his wife. Please choose the correct sequence of Emergency management for this patient, 

• IV fluid therapy, IV Insulin therapy 

• IV Insulin therapy followed by IV fluid therapy 

• IV fluid therapy only 

• IV Insulin therapy only 

8. Mr. Q was treated in the Emergency care for DKA and was under observation. Later he was found to be irritable, drowsy and suffering from a headache, and was suspected to have cerebral edema. What is the next course of treatment for Mr. A?

• No further treatment required

• Transition to SC Insulin form IV insulin 

• Give mannitol 0.5 - 1 g/kg or hypertonic solution, Transfer for ICU with specialist care

• Add 5% dextrose in the infusate  and adjust type of IV fluid based on serum sodium concentration after 4 - 6 hours

9. Ms. G came to the emergency department in shock with  reduced conscious level, the physician present diagnosed her with diabetic ketoacidosis (DKA) and resuscitation was done immediately. She was critically observed after she was stabilized. You noticed her BG level reached 15 mmol/L, what would be the next step of management?

• Mannitol administration, restriction of IV fluids

• Addition of dextrose, adjustment of IV fluid type based on serum sodium concentration 

• Initiate subcutaneous insulin 

• Initiate treatment for sepsis 

10.  After initial management for DKA, Ms. Z  showed signs of improvement, she is tolerating well with oral fluids and appears clinically well, what would be the next step of management?

• Mannitol administration and restrict fluid

• No further management is required 

• Start subcutaneous insulin and stop IV insulin immediately 

• Start subcutaneous insulin and stop IV insulin after an appropriate interval