An adult with DKA is being treated with IV fluids, insulin drip, and electrolyte replacement. Review the recovery trend across 6 hours and answer the questions.

Quick answer
The trend demonstrates progressive DKA resolution with glucose declining, anion gap narrowing, and pH/bicarbonate improving. At 6 hours, glucose is 210 mg/dL and anion gap is 14 mEq/L (still elevated). The correct action is to add dextrose to IV fluids while continuing the insulin drip to prevent hypoglycemia and allow continued ketone clearance.

Why this is correct
In DKA management, when glucose falls below 250 mg/dL, dextrose should be added to IV fluids to prevent hypoglycemia while insulin is continued until the anion gap closes. Stopping insulin prematurely would halt ketone suppression and worsen acidosis.

Clinical picture
The anion gap remains elevated at 14 mEq/L (normal 8-12), indicating ongoing ketonemia. Insulin is required to close the gap; dextrose provides substrate to prevent hypoglycemia during continued insulin infusion.

Memory hook
DKA resolution criteria: glucose <200 mg/dL, anion gap <12 mEq/L, bicarbonate ≥18 mEq/L, pH >7.30. Add dextrose when glucose <250 mg/dL while continuing insulin until anion gap closes.

NCLEX decision rule
Never stop insulin before the anion gap closes. Add dextrose when glucose approaches 200-250 mg/dL to prevent hypoglycemia.

Why the alternatives are wrong
Stopping the insulin drip would allow ketone production to resume. Switching to subcutaneous insulin without overlap risks rebound hyperglycemia and ketosis. Increasing insulin rate would accelerate glucose drop and cause hypoglycemia.