A 10-year-old (25 kg) with known type 1 DM presents in DKA with blood glucose 480 mg/dL, pH 7.12, bicarbonate 8 mEq/L. After initial fluid resuscitation, insulin infusion is started. What is the correct insulin infusion rate?

• A 0.1 units/kg/hour (2.5 units/hour) ✓
• B 0.025 units/kg/hour (0.625 units/hour)
• C 0.5 units/kg/hour (12.5 units/hour)
• D 1 unit/kg/hour (25 units/hour)

Explanation

In pediatric DKA, the standard insulin infusion rate is 0.1 units/kg/hour. For a 25 kg child, this equals 2.5 units/hour. Doses of 0.05 units/kg/hour may be used in very young or insulin-sensitive patients, but 0.1 units/kg/hour is the guideline-recommended standard dose. Bolus insulin is not recommended in pediatric DKA due to the risk of rapid osmotic shifts and cerebral edema.

Reference: Ghai Essential Pediatrics, 10th ed.

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