Question

A 49-year-old with suspected DKA: glucose 310 mg/dL, pH 7.28, β‑hydroxybutyrate elevated, anion gap 18. After initial fluids and insulin infusion, glucose falls to 190 mg/dL but anion gap persists. Next fluid step?

Accepted Answer

Switch to D5‑½NS while continuing insulin

Answer

Continue 0.9% saline only

Answer

Stop insulin

Answer

Give bicarbonate infusion

Answer

Switch to lactated Ringer's with no dextrose

Practice question

A 49-year-old with suspected DKA: glucose 310 mg/dL, pH 7.28, β‑hydroxybutyrate elevated, anion gap 18. After initial fluids and insulin infusion, glucose falls to 190 mg/dL but anion gap persists. Next fluid step?