A 23-year-old woman was admitted 8 hours ago to the intensive care unit, where you just started your shift, with a diagnosis of diabetic ketoacidosis. The patient is alert and oriented to person, place, and time. She feels slightly weak and complains of nausea and abdominal discomfort. She states she went on a weekend trip and forgot to take her insulin with her. Her blood pressure is 115/85 mm Hg with no orthostatic changes. Her pulse is 85/min, respirations are 15/min, and temperature is 37.3 C (99.1 F). The rest of her physical examination is unremarkable. You have been ordering serial laboratory tests every hour, and the latest results obtained are:
PO4- : Normal
Glucose: 302 mg/dl
K+ :5.1 mEq/L
The patient is currently on no food by mouth (NPO). She has good urine output and is on an insulin drip, receiving one-half normal saline solution as intravenous fluids with potassium supplementation. After you review the above lab findings and the patient’s current treatment plan, which of the following is the best next step in the management?
A. Add 5% dextrose to the intravenous fluids
B. Add phosphate to the intravenous fluids
C. Give 20 units of insulin (NPH) subcutaneously and stop the insulin drip
D. Hold potassium replacement in the intravenous fluids
E. Start the patient on a clear liquid diet
PO4- : Normal
Glucose: 302 mg/dl
K+ :5.1 mEq/L
The patient is currently on no food by mouth (NPO). She has good urine output and is on an insulin drip, receiving one-half normal saline solution as intravenous fluids with potassium supplementation. After you review the above lab findings and the patient’s current treatment plan, which of the following is the best next step in the management?
A. Add 5% dextrose to the intravenous fluids
B. Add phosphate to the intravenous fluids
C. Give 20 units of insulin (NPH) subcutaneously and stop the insulin drip
D. Hold potassium replacement in the intravenous fluids
E. Start the patient on a clear liquid diet