🏥 USMLE Exam Prep

A 68-year-old woman with type 2 diabetes presents to the emergency department with altered mental status. Her blood glucose is 850 mg/dL, serum osmolality is 330 mOsm/kg, and she has no ketones in her urine or serum. Which of the following is the most appropriate initial management step?

A Intravenous insulin bolus followed by continuous infusion
B Administration of intravenous 0.9% normal saline
C Bicarbonate infusion for acidosis
D Glucagon injection

✓ Correct Answer: Option B

This patient's presentation is consistent with Hyperosmolar Hyperglycemic State (HHS). Initial management prioritizes aggressive fluid resuscitation with isotonic saline to correct severe dehydration.

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