مريض حماض كيتوني سكري على تسريب أنسولين وريدي، نزل سكره من ٥٢٠ إلى ٢٤٠ ملغ/دل، وما زال الحماض موجوداً. ما التعديل المتوقع؟

A client with DKA is on an IV insulin infusion. Glucose has fallen from 520 to 240 mg/dL, but acidosis persists. What change is expected?

1. Switch at once to subcutaneous insulin and stop the IV
2. Add dextrose to the IV fluids and continue the insulin infusion
3. Stop the insulin infusion, as glucose is now near normal
4. Give sodium bicarbonate to correct the acidosis quickly

Answer: B) Add dextrose to the IV fluids and continue the insulin infusion. Insulin is given to stop ketone production and clear the acidosis, not just to lower glucose. Once glucose nears 200–250 mg/dL, dextrose is added so insulin can continue without hypoglycaemia. Stopping early lets the acidosis return, and bicarbonate is reserved for very severe acidosis.