ITE Diabetic Ketoacidosis and HHS 2

Question 1

A patient with DKA has a serum potassium of 5.8 mEq/L on presentation. When should potassium supplementation be initiated?

Accepted Answer

When potassium falls below 5.5 mEq/L

Answer

Immediately with insulin infusion

Answer

When potassium falls below 3.5 mEq/L

Answer

Only after anion gap closes

Question 2

Which of the following best explains the mechanism of anion gap metabolic acidosis in DKA?

Accepted Answer

Accumulation of beta-hydroxybutyrate and acetoacetate

Answer

Lactic acid accumulation from tissue hypoperfusion

Answer

Loss of bicarbonate through the kidneys

Answer

Hyperchloremia from normal saline administration

Question 3

A 28-year-old with type 1 DM presents with DKA. Blood glucose is 420 mg/dL and beta-hydroxybutyrate is elevated. After 8 hours of treatment, glucose is 180 mg/dL but pH remains 7.15 and anion gap is still elevated. What is the most appropriate next step?

Accepted Answer

Add dextrose to IV fluids and continue insulin

Answer

Increase insulin infusion rate

Answer

Stop insulin and reassess in 2 hours

Answer

Administer sodium bicarbonate

Question 4

What is the most common precipitating factor for DKA in patients with established type 1 diabetes?

Accepted Answer

Insulin omission

Answer

New onset diabetes

Answer

Infection or illness

Answer

Myocardial infarction

Question 5

A patient with HHS has a serum osmolality of 345 mOsm/kg and blood glucose of 1100 mg/dL. Which IV fluid is most appropriate for initial resuscitation?

Accepted Answer

0.9% NaCl (isotonic saline)

Answer

0.45% NaCl (hypotonic saline)

Answer

D5W (5% dextrose in water)

Answer

Lactated Ringer's solution

Question 6

Which laboratory finding would most strongly suggest HHS rather than DKA in a hyperglycemic patient?

Accepted Answer

Absence of significant ketonemia with pH > 7.3

Answer

Serum glucose > 600 mg/dL

Answer

Serum osmolality > 320 mOsm/kg

Answer

Blood urea nitrogen > 30 mg/dL

Question 7

A patient recovering from DKA develops worsening headache, confusion, and pupillary changes 6 hours into treatment. What is the most likely diagnosis?

Accepted Answer

Cerebral edema

Answer

Hypokalemia-induced arrhythmia

Answer

Hypoglycemia from insulin overdose

Answer

Septic encephalopathy