A 10-year-old child with type 1 diabetes presents with vomiting, abdominal pain, Kussmaul breathing, and blood glucose of 420 mg/dL. pH is 7.18, bicarbonate 8 mEq/L. Weight is 30 kg. Fluid resuscitation with normal saline 10 mL/kg has been given. What is the appropriate insulin infusion rate?

• A 0.05 units/kg/hour (1.5 units/hour)
• B 0.5 units/kg/hour (15 units/hour)
• C 0.02 units/kg/hour (0.6 units/hour)
• D 0.1 units/kg/hour (3 units/hour) ✓

Explanation

Current ISPAD guidelines for pediatric DKA recommend starting insulin infusion at 0.1 units/kg/hour after initial fluid resuscitation and at least 1 hour of IV fluids. For this 30 kg child, 0.1 units/kg/hour = 3 units/hour. Bolus doses of insulin are not recommended. Rates of 0.05 units/kg/hour may be considered in very young children or mild DKA. Higher rates increase risk of hypoglycemia and hypokalemia.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.