A 10-year-old (30 kg) with type 1 diabetes is being treated for DKA. Initial fluids and insulin infusion were started. After 4 hours, blood glucose has fallen to 180 mg/dL but the child remains acidotic with pH 7.18. Which of the following is the most appropriate next step in fluid management?

• A Add 5% dextrose to the IV fluids and continue insulin infusion ✓
• B Stop insulin infusion and switch to subcutaneous insulin
• C Administer 50 mL of 50% dextrose IV push
• D Increase the insulin infusion rate to correct acidosis faster

Explanation

In DKA, insulin must be continued until acidosis resolves (pH >7.3, bicarbonate >15), even if glucose normalizes. When blood glucose falls to 200 mg/dL, dextrose should be added to IV fluids (typically D5 or D10 in NS) to allow continued insulin infusion for acidosis correction while preventing hypoglycemia. Stopping insulin prematurely risks rebound ketoacidosis. Increasing insulin rate risks hypoglycemia and cerebral edema.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.