This patient is obviously in D.K.A. as evidenced by high serum glucose, glucosuria and ketonuria. What ones needs to do now is to resusciate the patient with FLUIDS! To reverse the ketone production that is contributing to the acidosis the patient also needs insulin BUT initially this is secondary to fluid resusciation. You do not want to be giving insulin to any patient without documented electrolytes. With the acidosis and dehydration, patients become potassium depleted. The committment acidosis will contribute to "shifting" potassium out of the cell giving you a falsely elevated potassium. The danger is if a patient is severly potassium depleted in the face of an acidosis, with the fluids correcting the acidosis, the insulin is going to shove more potassium into the cells thus acutely lowering the serum potassium level to potentially dangerous levels. If the potassium gets lower than 2.0-2.5 one is prone to provoking lethal arrhythmias.
