مريض في الحماض الكيتوني السكري، بعد ساعة من السوائل. الطبيب يريد بدء تسريب الإنسولين الوريدي. البوتاسيوم ٣٫١، والبول ٦٠ مل/ساعة، والتخطيط يظهر موجات U. ما التصرف الصحيح؟

A client in DKA has had an hour of fluids. The doctor wants to start IV insulin. Potassium is 3.1, urine 60 mL/h, and the ECG shows U waves. What is correct?

1. Give bicarbonate to raise potassium quickly
2. Replace potassium first and delay insulin until it rises
3. Start insulin immediately because glucose is very high
4. Stop fluids until potassium rises on its own

Answer: B) Replace potassium first and delay insulin until it rises. Insulin shifts potassium into cells, lowering it further and risking dangerous arrhythmias. If potassium is below 3.3, replace it first, then start insulin.