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
