An obese patient presented in casualty in an unconscious state. His blood sugar measured 400mg% urine tested positive for sugar and ketones Drug most useful in management is –
**Core Concept**
The patient's presentation is suggestive of diabetic ketoacidosis (DKA), a serious complication of diabetes mellitus characterized by hyperglycemia, metabolic acidosis, and ketosis. The key underlying pathophysiology involves impaired insulin action, leading to increased glucose levels and subsequent lipolysis, resulting in the production of ketone bodies.
**Why the Correct Answer is Right**
In DKA, the primary goal of management is to restore euglycemia, correct acidosis, and improve fluid status. Insulin therapy is essential to decrease glucose production, enhance glucose uptake in tissues, and inhibit lipolysis. **Regular insulin** is the preferred choice for managing DKA due to its rapid onset of action, allowing for quick correction of hyperglycemia and metabolic acidosis. Regular insulin also has a shorter duration of action, which enables easier titration and adjustment of doses.
**Why Each Wrong Option is Incorrect**
**Option A:** This option might be tempting, but **metformin** is not the first-line treatment for DKA. Although metformin can help improve insulin sensitivity, it is not effective in the acute setting of DKA due to its delayed onset of action and potential for lactic acidosis.
**Option B:** **Glucagon** is actually contraindicated in DKA, as it can worsen hyperglycemia and ketosis by stimulating glycogenolysis and gluconeogenesis.
**Option C:** **Thiazide diuretics** may worsen dehydration and electrolyte imbalance in DKA, making them a poor choice for management.
**Clinical Pearl / High-Yield Fact**
When managing DKA, it's essential to remember the "Fluid, Electrolytes, Insulin, and Ketone (FEIK) protocol": initial fluid replacement (Fluid), followed by correction of electrolyte imbalances (Electrolytes), administration of insulin (Insulin), and monitoring of ketone levels (Ketone).
**Correct Answer: B. Glucagon.**