In DKA management, when should dextrose be added to IV fluids?

In DKA management, when should dextrose be added to IV fluids?

• A. Do not add dextrose.
• B. Add dextrose to IV fluids when glucose approaches 200 mg/dL.
• C. Use dextrose-containing fluids from start.
• D. Switch to LR.

Answer: (B)

In DKA, you start with IV fluids to restore volume and then give insulin to halt ketone production and correct hyperglycemia. You monitor glucose closely, and as soon as it drops toward 200 mg/dL, you add dextrose to the IV fluids. This keeps the blood glucose from falling too low while you continue the insulin infusion to finish resolving ketosis and correct acidosis. Using dextrose-containing fluids at this point allows you to maintain ongoing insulin therapy without risking hypoglycemia, since insulin will keep driving glucose into cells and suppress ketogenesis. Starting dextrose earlier isn’t necessary and could complicate glucose control, and switching to a fluid like lactated Ringer’s doesn’t address the need for a glucose source once glucose nears 200 mg/dL.

In DKA, you start with IV fluids to restore volume and then give insulin to halt ketone production and correct hyperglycemia. You monitor glucose closely, and as soon as it drops toward 200 mg/dL, you add dextrose to the IV fluids. This keeps the blood glucose from falling too low while you continue the insulin infusion to finish resolving ketosis and correct acidosis. Using dextrose-containing fluids at this point allows you to maintain ongoing insulin therapy without risking hypoglycemia, since insulin will keep driving glucose into cells and suppress ketogenesis.

Starting dextrose earlier isn’t necessary and could complicate glucose control, and switching to a fluid like lactated Ringer’s doesn’t address the need for a glucose source once glucose nears 200 mg/dL.