Internal Medicine Exam Diabetic Ketoacidosis Management 3

Question 1

A patient in DKA is started on a normal saline infusion. After 2 liters, serum chloride is 112 mEq/L. What complication is developing?

Accepted Answer

Hyperchloremic non-anion gap metabolic acidosis

Answer

Large volumes of normal saline can cause hyperchloremic non-anion gap metabolic acidosis, which may obscure DKA resolution.

Question 2

Which ketone body is predominantly elevated in DKA but NOT detected by the nitroprusside urine ketone test?

Accepted Answer

Beta-hydroxybutyrate

Answer

Beta-hydroxybutyrate is the predominant ketone in DKA but is not detected by nitroprusside-based urine/serum ketone tests.

Question 3

A 45-year-old with type 2 diabetes on an SGLT-2 inhibitor presents with glucose of 210 mg/dL, pH 7.21, and elevated ketones. What is this presentation called?

Accepted Answer

Euglycemic DKA

Answer

SGLT-2 inhibitors can cause euglycemic DKA — elevated ketones and metabolic acidosis with near-normal blood glucose.

Question 4

What is the recommended initial fluid bolus for an adult presenting in DKA with moderate dehydration?

Accepted Answer

1 liter 0.9% NaCl over 1 hour

Answer

Initial resuscitation in DKA uses 1 L of isotonic (0.9%) normal saline over the first hour.

Question 5

In DKA management, when is sodium bicarbonate administration currently recommended by most guidelines?

Accepted Answer

pH < 7.10 with hemodynamic instability or severe hyperkalemia

Answer

Sodium bicarbonate is generally reserved for severe acidosis (pH <7.0–7.1) complicated by hemodynamic compromise or life-threatening hyperkalemia.

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Internal Medicine Exam Diabetic Ketoacidosis Management 3