Step 2

Endocrine 2

A 21-year-old woman presents to the emergency department via emergency medical services after being found somnolent and difficult to arouse in her dorm room by her roommate this morning. Past medical history is only notable for heavy menstrual periods. Current medications include only an ethinyl estradiol/norgestimate oral contraceptive pill. Her father has hypertension and hyperlipidemia, and her mother has rheumatoid arthritis. The patient drinks 3 alcoholic beverages on the weekends and does not use tobacco products. The patient’s roommate states she occasionally smokes marijuana and is not aware of any other substance use. The patient’s roommate states for the last week, she has been unusually fatigued and her vision has been blurry. The patient attributed this to spending many hours on her computer writing her final paper for her senior project. Her roommate states she has also been drinking significantly more water and reported intermittent abdominal pain and general malaise. Vital signs are temperature 37.8°C (100.0°F), blood pressure 95/62 mmHg, pulse 110 beats/min, and respirations 28/min. Physical examination reveals a somnolent woman who rouses to sternal rub and is unable to follow commands. Her pupils are 4mm bilaterally and are reactive to light. Respirations are exaggerated and deep. There is a normal S1 and S2 and pulse is tachycardic but regular. Skin is erythematous and warm to touch diffusely. The patient has dry mucus membranes and increased skin turgor. Relevant laboratory findings include the following:

  • pH: 7.12
  • PaCO2: 18 mmHg
  • PaO2: 79 mmHg
  • Potassium: 3.0 mEq/L
  • Glucose: 682 mg/dL

Which of the following treatments is the most appropriate next step in management for this patient?

  • A) 0.9% NaCl
  • B) 0.9% NaCl with potassium replacement
  • C) 0.9% NaCl with sodium bicarbonate
  • D) Intravenous regular insulin bolus
  • E) SGLT2 inhibitor


Stephanie Katz


Dr. Ted O'Connell