Internal Medicine Exam Diabetic Ketoacidosis Management 2

Question 1

A patient with DKA has a serum potassium of 3.2 mEq/L on arrival. What is the correct next step before starting insulin?

Accepted Answer

Replace potassium to ≥3.5 mEq/L before starting insulin

Answer

Insulin drives potassium intracellularly, so potassium must be ≥3.5 mEq/L before insulin is started to prevent life-threatening hypokalemia.

Question 2

Which of the following best describes the anion gap in uncomplicated DKA?

Accepted Answer

Elevated anion gap metabolic acidosis

Answer

DKA causes elevated anion gap metabolic acidosis due to accumulation of beta-hydroxybutyrate and acetoacetate.

Question 3

A 28-year-old with type 1 diabetes presents with DKA. Blood glucose is 520 mg/dL. After 1 hour of insulin infusion, glucose drops to 250 mg/dL. What should be added to IV fluids?

Accepted Answer

Add dextrose to IV fluids and continue insulin

Answer

Dextrose is added to IV fluids when glucose reaches 200–250 mg/dL to allow continued insulin infusion and ketone clearance.

Question 4

Which laboratory finding is most consistent with resolution of DKA and readiness to transition to subcutaneous insulin?

Accepted Answer

Serum bicarbonate ≥ 18 mEq/L and anion gap ≤ 12

Answer

Resolution criteria include anion gap ≤12 mEq/L, serum bicarbonate ≥18 mEq/L, and pH >7.3 — all three should be met before transitioning.

Question 5

A patient is transitioning from insulin drip to subcutaneous insulin after DKA resolution. How long should the insulin drip overlap with the first subcutaneous dose?

Accepted Answer

1–2 hour overlap

Answer

The insulin drip should overlap with subcutaneous insulin for 1–2 hours to prevent rebound hyperglycemia and ketoacidosis.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Diabetic Ketoacidosis Management 2