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

Potassium supplementation should be added to IV fluids when serum K+ falls below 5.5 mEq/L to prevent hypokalemia from insulin-driven cellular uptake.

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

DKA causes anion gap acidosis due to accumulation of ketoacids (beta-hydroxybutyrate and acetoacetate) from unregulated fatty acid oxidation.

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

When glucose falls below 200-250 mg/dL before anion gap closes, dextrose should be added to IV fluids to allow continuation of insulin until ketoacidosis resolves.

Question 4

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

Accepted Answer

Insulin omission

Answer

Insulin omission (non-adherence) is the most common precipitating cause of DKA in patients with known type 1 diabetes.

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

Isotonic normal saline (0.9% NaCl) is used first in HHS to restore circulating volume before transitioning to hypotonic fluids for free water replacement.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Diabetic Ketoacidosis and HHS 2