Internal Medicine Exam Diabetic Ketoacidosis Management 5

Question 1

A patient with DKA has a serum osmolality of 340 mOsm/kg and an altered mental status. What additional diagnosis should be considered?

Accepted Answer

Overlapping hyperosmolar hyperglycemic state (mixed DKA/HHS)

Answer

Serum osmolality >320 mOsm/kg with DKA criteria suggests a mixed DKA/HHS state, which requires attention to osmolarity during fluid replacement.

Question 2

Which of the following is the most common electrolyte abnormality requiring monitoring after DKA resolution?

Accepted Answer

Hypokalemia

Answer

As insulin drives potassium intracellularly and urinary losses are repleted slowly, hypokalemia is the most common electrolyte complication after DKA treatment.

Question 3

A patient with DKA secondary to new-onset type 1 diabetes is being discharged. Which statement about follow-up insulin management is most accurate?

Accepted Answer

Both basal and prandial insulin regimens should be established prior to discharge

Answer

Patients with new-onset type 1 diabetes should be discharged on a basal-bolus insulin regimen with diabetes education and close follow-up.

Question 4

Which arterial blood gas pattern is most consistent with DKA with appropriate respiratory compensation?

Accepted Answer

pH 7.22, PaCO2 28, HCO3 11

Answer

DKA causes metabolic acidosis with respiratory compensation (Kussmaul breathing lowers PaCO2); the expected PaCO2 = 1.5 × HCO3 + 8 ± 2.

Question 5

An elderly patient with DKA develops oliguria despite 3 liters of IV fluids. Creatinine rises from 1.2 to 3.8 mg/dL. What complication has occurred?

Accepted Answer

Acute kidney injury from hypovolemia and hypoperfusion

Answer

Severe dehydration and hypoperfusion in DKA commonly cause prerenal or intrinsic acute kidney injury, which may not reverse promptly with fluid resuscitation.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Diabetic Ketoacidosis Management 5