Her respiratory rate is 23 and she is taking deep breaths. Her pulse is 98 and regular. Temperature is normal. Lab studies show that the Glucose is 458, Na 138, K 4.5, Cl 101, HCO3 14, BUN 67, Cr 1.6. CBC shows Hb 13.2. WBC 13, Platelets 243 and a normal differential count.

You test for acetone in blood and it comes back positive. You start her on Insulin IV and NSS at 125 cc/hr. Her glucose level is checked every hour. After 2 hours you are called about her glucose level being 58. The electrolytes are being checked every 2 hours and they show a Na of 138, K 3.7, Cl 103, HCO3 19, BUN 34 and Cr 1.4.

Your next step should be :

1. Stop the insulin drip because the patient is becoming hypoglycemic
2. Stop the Insulin and give the patient 50 cc of 50% dextrose(D50) IV
3. Continue the insulin, give the patient 50 cc of D50 and start a drip of 10% dextrose continuously
4. Stop Insulin, Give 50 cc of D50 and start D10 continuously
5. Consult an endocrinologist because this may not be ketoacidosis at all