A 59-year-old with DKA is now glucose 220 mg/dL, anion gap 12 (was 24), bicarbonate 16 mEq/L, and ketones still present. Next insulin/fluids step?...

Question

A 59-year-old with DKA is now glucose 220 mg/dL, anion gap 12 (was 24), bicarbonate 16 mEq/L, and ketones still present. Next insulin/fluids step?

Accepted Answer

Continue insulin until ketoacidosis resolves; add dextrose when glucose

Answer

Stop insulin infusion now

Answer

Continue insulin and add dextrose to fluids to maintain glucose 150-200 mg/dL until ketosis resolves

Answer

Give bicarbonate to close the gap

Answer

No dextrose; keep insulin same and allow glucose to drop

"ada standards of care (2025): hyperglycemic crises" MCQ (SBA): Diabetic Ketoacidosis