MRCP2-1500

MRCP2-1500

A 26-year-old woman presents to the emergency department after being found unwell by friends. She has a history of vomiting and diarrhea for the past three days and her housemate reports that she has not been taking her regular insulin. The patient is disorientated and unable to provide any history. On examination, she is dehydrated with abdominal tenderness but no focal peritonism. Her vital signs show a blood pressure of 86/57 mmHg, heart rate of 127 beats per minute, respiratory rate of 28 per minute, and O2 saturations of 100% on room air. Her fingerpick blood glucose is 38.2 mmol/L and blood ketones are 8.7 mmol/L. Arterial blood gas shows a pH of 7.05, PaCO2 of 15 mmHg, PaO2 of 99 mmHg, bicarbonate of 12.3 mmol/L, chloride of 111 mmol/L, and lactate of 7.5 mmol/L. What is the appropriate strategy for intravenous insulin treatment in this patient?