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DKA Dextrose Addition — RACP Adult Medicine MCQ

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ModerateEndocrinologyDKA Dextrose AdditionRACP Adult Medicine

A 22-year-old woman with DKA is receiving IV insulin infusion and IV normal saline. After 4 hours, blood glucose has dropped from 30 to 14 mmol/L. However, ketones remain elevated at 4.2 mmol/L and pH is 7.22. What is the most appropriate next step?

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Correct answer: B — Continue same insulin rate and add IV 10% dextrose

In DKA, blood glucose falls faster than ketone clearance. Stopping or reducing insulin because glucose is improving risks persistent ketoacidosis. The correct approach is to continue the same insulin infusion rate and add 10% dextrose (or 5% dextrose) when glucose falls below 14 mmol/L. This allows ongoing ketone suppression while preventing hypoglycaemia. The goal is to clear ketones, not just normalise glucose.

Reference: ADS – 2024 – DKA Protocol; JBDS-IP 2024 DKA Guidelines