# Situation: A 22-year-old woman with type 1 diabetes mellitus is brought to the emergency department after two days of vomiting, during which she stopped taking her insulin. She weighs 58 kg. Diabetic ketoacidosis (DKA) is diagnosed, and she is admitted to the intensive care unit. Regular insulin is to run at 0.1 units/kg/h. The pharmacy sends 50 units of regular insulin in 100 mL of 0.9% sodium chloride. At what rate should the nurse set the infusion pump? Round off to one decimal place.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630028  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 22-year-old woman with type 1 diabetes mellitus is brought to the emergency department after two days of vomiting, during which she stopped taking her insulin. She weighs 58 kg. Diabetic ketoacidosis (DKA) is diagnosed, and she is admitted to the intensive care unit.

Regular insulin is to run at 0.1 units/kg/h. The pharmacy sends 50 units of regular insulin in 100 mL of 0.9% sodium chloride. At what rate should the nurse set the infusion pump? Round off to one decimal place.

## 보기

1. 11.6 mL/h **✔ 정답**
2. 5.8 mL/h
3. 2.9 mL/h
4. 116.0 mL/h

**정답: 1**

## 해설

The dose is 0.1 units/kg/h × 58 kg = 5.8 units/h. The concentration is 50 units ÷ 100 mL = 0.5 unit/mL. The rate is 5.8 units/h ÷ 0.5 unit/mL = 11.6 mL/h.

## 심화 해설

Calculating the Insulin Infusion Rate

The prescribed insulin dose is weight-based at 0.1 units/kg/h. For a patient weighing 58 kg, the required hourly dose is calculated as:

0.1 units/kg/h × 58 kg = 5.8 units/h

The pharmacy-prepared solution contains 50 units of regular insulin diluted in 100 mL of 0.9% sodium chloride. This yields a concentration of:

50 units ÷ 100 mL = 0.5 units/mL

To deliver 5.8 units/h using a solution with 0.5 units/mL, the infusion pump rate is:

5.8 units/h ÷ 0.5 units/mL = 11.6 mL/h

Key point! Always confirm the concentration on the pharmacy label before programming the pump. A common error is using the total volume (100 mL) as the hourly rate, which would deliver the entire 50 units in one hour — a massive overdose. The correct rate reflects only the dose needed per hour.

Watch out! In DKA, regular insulin is given as a continuous intravenous infusion because its short half-life allows rapid titration. The infusion is typically continued until the anion gap closes and blood glucose stabilizes, not simply until glucose normalizes. Frequent blood glucose monitoring (usually hourly) guides rate adjustments.

| Calculation Step | Formula | Result |
| --- | --- | --- |
| Hourly insulin dose | 0.1 units/kg/h × 58 kg | 5.8 units/h |
| Solution concentration | 50 units ÷ 100 mL | 0.5 units/mL |
| Infusion pump rate | 5.8 units/h ÷ 0.5 units/mL | 11.6 mL/h |

The 2024 ADA/EASD consensus report on hyperglycemic crises emphasizes that intravenous regular insulin should be administered as a continuous infusion, with the initial rate based on weight and adjusted according to serial glucose and ketone measurements [1]. The dosing approach in this question — 0.1 units/kg/h — aligns with the guideline-recommended starting range for adult DKA management. Accurate pump programming is a direct nursing responsibility that prevents both under-treatment (persistent ketosis) and over-treatment (hypoglycemia, hypokalemia).References (research sources)

- [1]Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.GuidelineUmpierrez GE, Davis GM, ElSayed NA, Fadini GP, Galindo RJ, Hirsch IB, Klonoff DC, McCoy RG, Misra S, Gabbay RA, Bannuru RR, Dhatariya KK. (2024) · DOI: 10.2337/dci24-0032

## 임상 시나리오

DKA Insulin Infusion Rate CalculationWeight-based dosing to pump programming
Calculate hourly insulin dose: 0.1 units/kg/h × 58 kg = 5.8 units/h. Confirm solution concentration: 50 units in 100 mL = 0.5 units/mL. Set pump to 11.6 mL/h.

Always verify the pharmacy label for concentration before programming. The pump rate reflects only the hourly dose, not the total bag volume.

CautionProgramming 100 mL/h would deliver the entire 50 units in one hour, a massive overdose. Continue IV insulin until the anion gap closes, not just when glucose normalizes.

## 핵심 개념

- **Diabetic ketoacidosis (DKA)** — A serious diabetes complication with hyperglycemia, ketosis, and metabolic acidosis requiring IV insulin and fluids.
- **Regular insulin infusion** — Short-acting insulin given IV for rapid titration in DKA until anion gap closes.
- **Anion gap** — Calculated as sodium minus chloride plus bicarbonate; elevated in DKA due to ketoacids.
- **Units per mL** — Concentration of an insulin solution, calculated by dividing total units by total volume.
- **Infusion pump rate** — Hourly volume delivered, calculated as dose per hour divided by concentration.

## 같은 주제 문제

- [Situation: A 58-year-old man with severe community-acquired pneumonia is intubated in the …](https://mymerci.kr/pages/nclex_q.php?qn_id=630016)
- [Situation: A 58-year-old man with severe community-acquired pneumonia is intubated in the …](https://mymerci.kr/pages/nclex_q.php?qn_id=630017)
- [Situation: A 58-year-old man with severe community-acquired pneumonia is intubated in the …](https://mymerci.kr/pages/nclex_q.php?qn_id=630018)
- [Situation: A 58-year-old man with severe community-acquired pneumonia is intubated in the …](https://mymerci.kr/pages/nclex_q.php?qn_id=630019)
- [Situation: A 62-year-old man arrives at the emergency department of a provincial hospital …](https://mymerci.kr/pages/nclex_q.php?qn_id=630020)
- [Situation: A 62-year-old man arrives at the emergency department of a provincial hospital …](https://mymerci.kr/pages/nclex_q.php?qn_id=630021)
- [Situation: A 62-year-old man arrives at the emergency department of a provincial hospital …](https://mymerci.kr/pages/nclex_q.php?qn_id=630022)
- [Situation: A 70-year-old woman with rheumatic heart disease is in the coronary care unit. …](https://mymerci.kr/pages/nclex_q.php?qn_id=630023)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._