24-year-old woman with type 1 diabetes mellitus and poor compliance is admitted to the ICU

A 24-year-old woman with type 1 diabetes mellitus and poor compliance is admitted to the intensive care unit where she is diagnosed with diabetic ketoacidosis.

Initial laboratory findings include positive serum ketones, a blood glucose level of 525 mg/dL, arterial pH of 7.09, a potassium level of 4.5 mg/dL, and a sodium level of 128 mg/dL.

She is anxious and complains of nausea and abdominal pain. She is not confused.

What is the first therapeutic intervention after admission to the intensive care unit?

• subcutaneous insulin detemir 25 units
• restore circulating volume with boluses of normal saline
• sliding scale insulin
• intravenous bolus of regular insulin 0.15 units/kg

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