In a patient with diabetic ketoacidosis started on 0.45% sodium chloride infusion and IV insulin, which finding indicates the intravenous fluids need to be changed?

In a patient with diabetic ketoacidosis started on 0.45% sodium chloride infusion and IV insulin, which finding indicates the intravenous fluids need to be changed?

• A. Blood pressure drop
• B. Urine ketones positive
• C. Blood glucose level is 252 mg/dL
• D. Serum sodium low

Answer: (C)

In diabetic ketoacidosis, fluid management is adjusted as blood glucose changes while insulin is given. The goal is to keep insulin therapy continuing to clear ketones while preventing hypoglycemia, so you switch to a glucose-containing fluid when glucose remains elevated but insulin is still being infused. A blood glucose reading of 252 mg/dL while receiving IV insulin signals that you should transition to a fluid that includes dextrose (glucose) so insulin can continue to work safely toward correcting ketosis without letting glucose stay too high or drop too low. The other signs point to different issues: a dropping blood pressure calls for more volume with isotonic saline, ongoing ketosis is shown by urine ketones but doesn’t by itself mandate a fluid change, and a low serum sodium affects electrolyte management but isn’t the trigger to add glucose to the IV fluids.

In diabetic ketoacidosis, fluid management is adjusted as blood glucose changes while insulin is given. The goal is to keep insulin therapy continuing to clear ketones while preventing hypoglycemia, so you switch to a glucose-containing fluid when glucose remains elevated but insulin is still being infused. A blood glucose reading of 252 mg/dL while receiving IV insulin signals that you should transition to a fluid that includes dextrose (glucose) so insulin can continue to work safely toward correcting ketosis without letting glucose stay too high or drop too low. The other signs point to different issues: a dropping blood pressure calls for more volume with isotonic saline, ongoing ketosis is shown by urine ketones but doesn’t by itself mandate a fluid change, and a low serum sodium affects electrolyte management but isn’t the trigger to add glucose to the IV fluids.