An 18 year-old female presents with altered consciousness and fruity breath. Which medication is indicated?

The presentation of altered consciousness alongside fruity breath in an 18-year-old female suggests diabetic ketoacidosis (DKA). This condition is often seen in individuals with Type 1 diabetes and can be characterized by metabolic acidosis and ketone production, leading to the fruity odor due to the presence of acetone. In such a case, the primary goal is to stabilize the patient, which includes addressing hyperglycemia and acidosis.

Regular insulin is the indicated medication because it is effective in rapidly lowering blood glucose levels and plays a crucial role in the treatment of DKA. Administering regular insulin will help reduce blood glucose by promoting glucose uptake into cells and inhibiting the production of ketones in the liver, thus addressing the underlying cause of the altered consciousness.

The other medications listed are not suitable for the acute management of DKA. NPH insulin, which is an intermediate-acting insulin, would not be effective in an emergency situation where rapid control of blood glucose is needed. Metformin is contraindicated in DKA due to its association with lactic acidosis, particularly since DKA already causes metabolic acidosis. Glyburide is a sulfonylurea used primarily in Type 2 diabetes and is not appropriate for treating an acute D