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.
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
In this patient your first step in management would be:
Start up an infusion of 0.9% sodium chloride
Start the patient on intravenous broad spectrum antibiotics
Start the patient on low dose intravenous insulin
Treat with intravenous bicarbonate
Insert a nasogastric tube to prevent aspiration pneumonia