Stage 6 — Evaluate outcomes. Review the 6-hour trend and select the best interpretation and next plan using current DKA resolution criteria.
Trend
Choose your responses, then check the answer.
Explanation
Trend interpretation At hour 6, beta-hydroxybutyrate is below 0.6 mmol/L, pH is at least 7.3, bicarbonate is at least 18 mmol/L, and glucose is below 200 mg/dL, so DKA resolution criteria are met. Give the planned basal-bolus insulin with at least 1 to 2 hours of IV overlap, continue safety monitoring, and address sick-day insulin use and the cause of omission before discharge.
Step 1 — Follow the whole trajectory Glucose, beta-hydroxybutyrate, pH, bicarbonate, potassium, perfusion, and urine output all improve. Dextrose was appropriately added when glucose fell below 250 mg/dL so insulin could continue clearing ketones.
Step 2 — Apply current resolution criteria Resolution requires beta-hydroxybutyrate below 0.6 mmol/L and venous pH at least 7.3 or bicarbonate at least 18 mmol/L; glucose is ideally below 200 mg/dL. Anion gap and urine ketones should not be used as the primary resolution endpoint because treatment can make them misleading.
Step 3 — Transition without an insulin gap Administer basal-bolus subcutaneous insulin with at least 1 to 2 hours of overlap before stopping IV insulin. The purpose is to prevent rebound hyperglycemia and recurrent ketoacidosis.
Step 4 — Prevent recurrence Before discharge, confirm access to insulin and monitoring supplies, teach that basal insulin generally continues during illness unless specifically directed otherwise, review glucose and ketone monitoring and when to seek help, and address the actual reason for insulin omission.
NCLEX rule Resolution requires ketone and acid-base recovery plus a safe transition and recurrence-prevention plan.
Scenario (Stage 6 — Evaluate outcomes)Determine whether ketoacidosis has resolved and choose a transition plan that avoids an insulin gap.
Clinical judgment targetUse beta-hydroxybutyrate and acid-base recovery rather than anion gap alone.
Biochemical DKA resolution — Beta-hydroxybutyrate below 0.6 mmol/L with venous pH at least 7.3 or bicarbonate at least 18 mmol/L.
Rebound ketoacidosis — Recurrence caused by an interruption in effective insulin or unresolved precipitating factors after IV therapy is stopped.
Sick-day plan — Instructions for continuing insulin, monitoring glucose and ketones, hydration, carbohydrate intake, clinician contact, and emergency warning signs during illness.