Which is the recommended treatment for hyperglycemia in a metabolic crisis?

• A. large dose of insulin and IV fluids w/Na
• B. IV glucose
• C. oral fluids only
• D. rest and observe

Answer: (A)

When a metabolic crisis with high blood glucose occurs, the priority is to reverse dehydration, correct electrolyte imbalances, and stop ongoing ketone production. That’s achieved with aggressive IV fluids and insulin therapy. Fluid resuscitation, typically with isotonic saline, restores circulating volume and improves renal perfusion so the kidneys can excrete glucose and ketones. Simultaneously, giving insulin IV helps shut down lipolysis and ketogenesis and rapidly lowers glucose, addressing the root metabolic disturbances.

Including sodium in the IV fluids is important because large fluid losses and hyperglycemia dilute and deplete extracellular sodium; maintaining sodium helps correct osmolality and supports overall correction of the metabolic derangements. Insulin also drives potassium into cells, so potassium levels must be monitored and managed to avoid dangerous shifts.

Other approaches, like IV glucose alone, oral fluids only, or simply resting and waiting, don’t address the critical combination of dehydration, acidosis from ketones, and electrolyte disturbances, so they aren’t appropriate as primary treatment for this crisis.