Emergency BriefcaseTeaching Library
Interactive clinical case

Diabetic Ketoacidosis

A 24-year-old with type 1 diabetes presents with vomiting, dehydration and Kussmaul respirations.

Score: 0/100Case progress: 1/3Critical actions: 0/3
1
Initial data

The case begins

A 24-year-old with type 1 diabetes presents with vomiting, dehydration and Kussmaul respirations.

Glucose 468 · Na 132 · K 5.5 · bicarbonate 11 · β-hydroxybutyrate elevated.

Which of the following is the most appropriate next step?

2
After initial fluids

New information

Select Reveal results to continue.

Glucose is 340 and potassium has fallen to 3.2 mEq/L.

Which of the following is the most appropriate next step?

3
Four hours later

New information

Select Reveal results to continue.

Glucose 190 but ketonemia and acidosis persist.

Which of the following is the most appropriate next step?

Must not miss

Critical actions

Calculator / interpretation

Enter values and calculate.

Interpretation rule

Use the result as decision support. Reconcile it with physiology, trajectory, local protocol and specialist input.

Error prevention

Common mistakes—and how to mitigate them

Insulin before potassium review

Mitigation: Know and trend potassium before insulin.

Stopping at normal glucose

Mitigation: Use ketone/acid-base resolution criteria.

Missing the trigger

Mitigation: Search for infection, ischemia, medication failure and access barriers.

Recap

What the learner should carry forward

  1. DKA care is coordinated replacement of volume, insulin and electrolytes—not glucose reduction alone.
  2. Insulin and correction of acidosis shift potassium intracellularly. Anticipate the fall.
  3. Resolution is biochemical and clinical; euglycemia can occur before ketogenesis stops.

Final score interpretation: 80–100 = strong; 50–79 = review missed decisions; below 50 = repeat the case.

Clinical boundary

Educational content only. Apply current local protocols, patient-specific factors, consultant guidance and clinical judgment.