What type of medical error occurs when a physician only provides hydration and discharges a patient with diabetic ketoacidosis (DKA) without initiating insulin therapy, leading to a worsening of the patient's condition?

Error of Omission

This scenario represents a classic error of omission—the physician failed to initiate insulin therapy, which is the cornerstone of DKA management and absolutely required to reverse the metabolic crisis. 1

Understanding the Error Type

An error of omission occurs when a healthcare provider fails to perform a necessary action or provide required treatment. In this case:

• The physician provided only hydration but omitted the essential insulin therapy that is mandatory for DKA resolution 1, 2
• Insulin is required to reverse ketoacidosis by suppressing ketone production and correcting the metabolic acidosis that defines DKA 2, 3
• Without insulin, DKA cannot resolve regardless of how much fluid is administered, leading to continued metabolic deterioration 1, 4

Why This is NOT Other Error Types

Not an Error of Commission

• Errors of commission involve performing an incorrect action or administering wrong treatment 5
• The physician didn't give the wrong medication—they simply failed to give the necessary one 1

Not an Error of Documentation

• Documentation errors involve failure to properly record care provided 5
• The problem here is the actual clinical management, not the medical record 1

Not an Error of Interpretation

• Interpretation errors involve misreading test results or misdiagnosing the condition 5
• The physician apparently recognized DKA (hence providing hydration) but failed to provide complete treatment 1

The Critical Omission in DKA Management

Standard DKA treatment requires both fluid resuscitation AND insulin therapy: 1

• Continuous IV insulin infusion is the preferred treatment for moderate to severe DKA, typically starting with 0.1 units/kg/hour 1, 3
• Fluid resuscitation alone addresses only the volume depletion but does nothing to reverse the underlying metabolic crisis of ketoacidosis 2, 4
• The triad of DKA (hyperglycemia, ketoacidosis, and metabolic acidosis) requires insulin to resolve, as insulin suppresses lipolysis and ketogenesis 2, 3

Clinical Consequences of This Omission

The patient's worsening condition was predictable and preventable: 1, 2

• Without insulin, ketone production continues unabated despite fluid administration 2
• Metabolic acidosis persists and worsens, leading to potential cardiovascular collapse, cerebral edema, and death 3, 4
• This represents a fundamental failure to provide standard-of-care treatment for a life-threatening emergency 1

Common Pitfall

This error highlights a critical knowledge gap: DKA requires multimodal therapy, not just one component. 1 The complete treatment protocol includes fluid resuscitation, insulin therapy, electrolyte replacement (especially potassium), and treatment of precipitating factors 1, 3. Omitting any essential component, particularly insulin, constitutes substandard care with potentially fatal consequences 2, 4.

Answer: A) Error of omission