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 BOF 9

 

   

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BOF: 9

A 50-year-old male is brought into the casualty ward having been found unconscious by his son.

He is a known insulin dependent diabetic who has not been taking his medication on a regular basis. He does not attend follow up or see his GP on a regular basis.

On examination he is febrile, has decreased skin turgor, pulse rate 120 beats per minute BP 90/70 he has deep sighing respiration but lungs are clear. He is drowsy but responds to pain, no neck stiffness or Kernig’s sign. There is cellulitis of his right lower limb.

Investigations:

Hb 14.5g/dL

WBC 17.4x 109/L

Blood urea 12.4 mmol/L

Creatinine 114 micromoles/L

Blood gases pH 7.1, pa CO2 3.0 kPa, paO2 12.5 kPa

In this patient your first step in management would be:

a)      Start up an infusion of 0.9% sodium chloride

b)      Start the patient on intravenous broad spectrum antibiotics

c)      Start the patient on low dose intravenous insulin

d)      Treat with intravenous bicarbonate

e)      Insert a nasogastric tube to prevent aspiration pneumonia

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