question: Q:An 8-year old boy is brought to the emergency department because he has been lethargic and has had several episodes of nausea and vomiting for the past day. He has also had increased thirst over the past two months. He has lost 5.4 kg (11.9 lbs) during this time. He is otherwise healthy and has no history of serious illness. His temperature is 37.5 °C (99.5 °F), blood pressure is 95/68 mm Hg, pulse is 110/min, and respirations are 30/min. He is somnolent and slightly confused. His mucous membranes are dry. Laboratory studies show:
  Hemoglobin 16.2 g/dL
  Leukocyte count 9,500/mm3
  Platelet count 380,000/mm3
  Serum
  Na+ 130 mEq/L
  K+ 5.5 mEq/L
  Cl- 99 mEq/L
  HCO3- 16 mEq/L
  Creatinine 1.2 mg/dL
  Glucose 570 mg/dL
  Ketones positive
  Blood gases, arterial
  pH 7.25
  pCO2 21 mm Hg
  Which of the following is the most appropriate next step in management?"? 
  {'A': 'Intravenous hydration with 0.9% normal saline and insulin', 'B': 'Intravenous hydration with 5% dextrose solution and 0.45% normal saline', 'C': 'Intravenous hydration with 0.45% normal saline and insulin', 'D': 'Intravenous hydration with 0.9% normal saline and potassium chloride', 'E': 'Intravenous sodium bicarbonate\n"'},