A 7-year-old girl with diabetic ketoacidosis is on an insulin infusion at 0.05 units/kg/hr with 0.45% saline running. Two hours into treatment her blood glucose has fallen from 480 mg/dL to 240 mg/dL, pH is 7.16, and ketones persist. What adjustment is required?
- A Stop the insulin infusion until glucose stabilizes above 400 mg/dL
- B Double the insulin infusion rate to clear ketones faster
- C Add dextrose 5% to the intravenous fluids and continue the insulin infusion ✓
- D Switch to subcutaneous rapid-acting insulin immediately
Correct answer: C. Add dextrose 5% to the intravenous fluids and continue the insulin infusion
Explanation
Insulin must be continued until ketoacidosis resolves, since stopping it allows ongoing ketogenesis while hyperglycemia corrects faster than acidosis. When blood glucose falls to about 250 to 300 mg/dL, dextrose 5% is added to the fluids so the insulin infusion can run uninterrupted. Doubling insulin accelerates osmotic shifts and raises cerebral edema risk. Subcutaneous insulin is inappropriate until acidosis has resolved and the child is eating.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.