A 14-year-old female with no past medical history presents to the emergency department with nausea and abdominal pain. On physical examination, her blood pressure is 78/65, her respiratory rate is 30, her breath has a fruity odor, and capillary refill is > 3 seconds. Serum glucose is 820 mg/dL. After starting IV fluids, what is the next best step in the management of this patient?
AIntravenous Dextrose in water
BSubcutaneous insulin glargine
CIntravenous regular insulin
DIntravenous glucagon
ESubcutaneous insulin lispro
An 8-year old boy is brought to the emergency department because he has been lethargic and has had several episodes of nausea and vomiting for the past day. He has also had increased thirst over the past two months. He has lost 5.4 kg (11.9 lbs) during this time. He is otherwise healthy and has no history of serious illness. His temperature is 37.5 °C (99.5 °F), blood pressure is 95/68 mm Hg, pulse is 110/min, and respirations are 30/min. He is somnolent and slightly confused. His mucous membranes are dry. Laboratory studies show: Hemoglobin 16.2 g/dL Leukocyte count 9,500/mm3 Platelet count 380,000/mm3 Serum Na+ 130 mEq/L K+ 5.5 mEq/L Cl- 99 mEq/L HCO3- 16 mEq/L Creatinine 1.2 mg/dL Glucose 570 mg/dL Ketones positive Blood gases, arterial pH 7.25 pCO2 21 mm Hg Which of the following is the most appropriate next step in management?
AIntravenous hydration with 0.45% normal saline and insulin
BIntravenous hydration with 5% dextrose solution and 0.45% normal saline
CIntravenous sodium bicarbonate
DIntravenous hydration with 0.9% normal saline and insulin
EIntravenous hydration with 0.9% normal saline and potassium chloride
An 11-year-old boy is brought to the emergency department because he was found to have severe abdominal pain and vomiting in school. On presentation, he is found to be lethargic and difficult to arouse. His parents noticed that he was eating and drinking more over the last month; however, they attributed the changes to entering a growth spurt. Physical exam reveals deep and rapid breathing as well as a fruity odor on his breath. Which of the following sets of labs would most likely be seen in this patient?
AGlucose: 90 mg/dL, pH: 7.4, Bicarbonate: 24 mEq/L
BGlucose: 300 mg/dL, pH: 7.4, Bicarbonate: 24 mEq/L
CGlucose: 90 mg/dL, pH: 7.2, Bicarbonate: 10 mEq/L
DGlucose: 300 mg/dL, pH: 7.4, Bicarbonate: 10 mEq/L
EGlucose: 300 mg/dL, pH: 7.2, Bicarbonate: 10 mEq/L
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