mrcem2-0529

mrcem2-0529

A 65 year old female is brought into the emergency department with a history of increasing fatigue, weakness and nausea over the past week. Over the last 48 hours the patient has become increasingly confused. The patient has a past medical history of hypertension and osteoporosis. The patient’s observations and initial tests are shown below:

Blood pressure 90/60 mmHg
Pulse 110 bpm
Respiration rate 20 bpm
Oxygen saturations 98% on air
Na+ 142 mmol/l
K+ 4.2 mmol/l
Urea 20 mmol/l
Creatinine 110 µmol/l
Glucose 50 mmol/l
pH 7.35
Bicarbonate 20 mmol/l
Urinalysis Ketones + glucose +++

What is the most appropriate first line treatment?