Question

A 58‑year‑old man with suspected DKA is in the ED. After fluids and insulin started at 0.1 units/kg/hr, glucose falls to 240 mg/dL, anion gap 14 (still elevated), bicarbonate 16. Next step?

Accepted Answer

Reduce insulin and add dextrose‑containing fluids to continue ketone clearance

Answer

Stop insulin now

Answer

Switch to subcutaneous rapid‑acting insulin only

Answer

Give bicarbonate to close gap

Answer

Start potassium infusion only if K⁺ >5.5

Practice question

A 58‑year‑old man with suspected DKA is in the ED. After fluids and insulin started at 0.1 units/kg/hr, glucose falls to 240 mg/dL, anion gap 14 (still elevated), bicarbonate 16. Next step?