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Diabetic Ketoacidosis — RACP Paediatrics MCQ

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HardEndocrinologyDiabetic KetoacidosisRACP Paediatrics

A 10-year-old receiving appropriate fluids, potassium and fixed-rate insulin for DKA remains acidotic with ketones 3.2 mmol/L. Glucose has fallen from 18 to 7 mmol/L over two hours despite 5% glucose-containing fluid. What is the best adjustment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Increase IV glucose to 10% and continue insulin for ketone clearance

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

C is correct. RCH advises increasing IV glucose to 10% when glucose is low or falling too quickly while acidosis persists, allowing adequate insulin to continue suppressing ketogenesis. D stops the treatment required to resolve DKA and risks rebound ketonaemia. E reduces ketone clearance before using the recommended glucose-support strategy. A risks severe hyperglycaemia and osmotic disturbance; a concentrated bolus is for clinically important hypoglycaemia, not routine adjustment here. B is premature while significant ketosis and acidosis remain. Only if glucose continues to fall despite 10% glucose should insulin reduction be considered with specialist guidance.

Reference: Royal Children’s Hospital Melbourne: Diabetic ketoacidosis: https://www.rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/