ITE Diabetic Ketoacidosis and HHS 3

Question 1

A 55-year-old with type 2 DM on an SGLT2 inhibitor presents with fatigue, nausea, and blood glucose of 210 mg/dL. pH is 7.20, bicarbonate 12, and urine ketones are large. What is this presentation called?

Accepted Answer

Euglycemic DKA

Answer

Euglycemic DKA, associated with SGLT2 inhibitors, presents with ketoacidosis but relatively normal blood glucose due to glycosuria and altered glucagon/insulin ratio.

Question 2

What is the target rate of serum glucose reduction during the initial phase of DKA treatment?

Accepted Answer

50-75 mg/dL per hour

Answer

The recommended rate of glucose reduction in DKA is 50-75 mg/dL per hour to avoid rapid osmotic shifts that could precipitate cerebral edema.

Question 3

Which of the following is the most appropriate insulin regimen for mild DKA (pH 7.25-7.30, patient alert and tolerating oral intake)?

Accepted Answer

Subcutaneous rapid-acting insulin only

Answer

Mild DKA in a patient able to eat can be managed with subcutaneous rapid-acting insulin alone rather than IV infusion, per ADA guidelines.

Question 4

A patient with DKA has a corrected sodium of 148 mEq/L. How is corrected sodium calculated in hyperglycemia?

Accepted Answer

Add 1.6 mEq/L for every 100 mg/dL glucose above 100

Answer

Corrected sodium is calculated by adding 1.6 mEq/L (or 2.4 mEq/L per some guidelines) for every 100 mg/dL glucose above 100 to account for osmotic dilution.

Question 5

A patient with DKA has a serum phosphate of 1.1 mg/dL. Which complication is most closely associated with severe hypophosphatemia in DKA?

Accepted Answer

Respiratory muscle weakness and hemolytic anemia

Answer

Severe hypophosphatemia in DKA can cause respiratory muscle weakness, hemolysis, and rhabdomyolysis, though routine phosphate replacement is not recommended.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Diabetic Ketoacidosis and HHS 3