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DKA – insulin initiation — RACP Paediatrics MCQ

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ModerateEndocrineDKA – insulin initiationRACP Paediatrics

A child with DKA has been receiving IV fluids for 1 hour. Blood glucose is now 25 mmol/L. The serum potassium is 4.0 mmol/L. What is the most appropriate next step?

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Correct answer: D — Commence insulin infusion 0.1 units/kg/hr

After 1 hour of fluid resuscitation, an insulin infusion at 0.1 units/kg/hr should be commenced. Potassium replacement (40 mmol/L in maintenance fluids) should be started with the insulin if serum potassium is <5.5 mmol/L, as insulin drives potassium intracellularly. Total body potassium is depleted in DKA regardless of serum levels.

Reference: RCH Melbourne – 2023 – Diabetic Ketoacidosis CPG; ISPAD – 2022 – DKA Consensus Guidelines