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DKA Management — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesDKA ManagementRACP Adult Medicine

A 40-year-old man with type 1 diabetes is admitted with DKA (pH 7.05, glucose 35 mmol/L, K+ 6.2 mmol/L). He is commenced on IV normal saline and an insulin infusion. Four hours later, his glucose has fallen to 15 mmol/L but pH remains 7.15 and ketones are 4.5 mmol/L. What is the most appropriate next step?

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Correct answer: B — Add 5% or 10% glucose to the IV fluids and continue insulin

In DKA, once glucose falls to ~14–15 mmol/L, 5–10% glucose should be added to the IV fluids while continuing the insulin infusion. The insulin must continue until ketosis has resolved (ketones <0.6 mmol/L, pH >7.3, bicarbonate >15 mmol/L). Stopping insulin prematurely because glucose has fallen will lead to recurrence of ketosis. The glucose infusion prevents hypoglycaemia while allowing continued insulin-driven clearance of ketones.

Reference: ADS – 2023 – DKA Management Protocol; eTG – 2025 – Endocrinology