How to Management Acute Onset Abdominal Pain, Nausea, and Emesis

In Episode 42 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question: A 20-year-old woman presents to the emergency department with one day of abdominal pain, nausea, vomiting, and shortness of breath. She has been feeling “under the weather” for the past week with a cold. She has no significant past medical history and takes no medications. Prior to her cold, she had noticed that her appetite had increased, and she had been more thirsty than usual for the preceding two weeks. Family history is notable for hypothyroidism in her sister and Crohn’s disease in her mother. On examination, she is afebrile, heart rate is 115/min, respiratory rate is 25/min, and blood pressure is 112/75. Her mucous membranes are dry. Capillary refill time is 2-3 seconds. Respirations are deep. She has mild abdominal tenderness to palpation. The remainder of the examination is unremarkable. Laboratory results are positive for urine and serum ketones, as well as blood glucose of 360, sodium 134, potassium 4.5, bicarbonate 14, and chloride 100. Venous blood gas shows pH of 7.1. What is the next best step in management?

• Basal-bolus SQ insulin with infusion of 0.9% normal saline with bicarbonate
• Basal-bolus SQ insulin with infusion of 0.45% normal saline with IV K
• Basal-bolus SQ insulin with infusion of 0.9% normal saline with 5% dextrose
• Continuous IV insulin with infusion of 0.45% normal saline with bicarbonate
• Continuous IV insulin with infusion of 0.9% normal saline with IV K
• Continuous IV insulin with infusion of 0.45% normal saline with with 5% dextrose