Dextrose Administration in Diabetic Ketoacidosis

Introduction to DKA Management

The American Diabetes Association recommends switching to 5% dextrose in 0.45-0.75% NaCl when blood glucose falls below 250 mg/dL during DKA treatment, continuing the infusion at the same rate as crystalloid replacement fluids, targeting 50% of estimated fluid deficit replacement over the first 8-12 hours 1, 2
The standard protocol involves changing from 0.9% NaCl to 5% dextrose with 0.45-0.75% NaCl when glucose reaches 250 mg/dL, and continuing the same infusion rate used for initial fluid resuscitation, aiming to replace 50% of fluid deficit in the first 8-12 hours 1, 2

The American College of Clinical Endocrinologists recommends continuing insulin infusion at a standard rate of 0.05-0.10 units/kg/hour when adding dextrose, until DKA resolves, defined as pH >7.3, bicarbonate >15 mEq/L, and anion gap closure 1
Insulin infusion should not be stopped or reduced when adding dextrose, with the goal of continuing to clear ketones while preventing hypoglycemia 1, 2

The American Association of Clinical Endocrinologists recommends checking blood glucose every 2-4 hours during dextrose infusion, and monitoring electrolytes, renal function, venous pH, and osmolality every 2-4 hours until stable 1
Potassium levels should be maintained between 4-5 mEq/L throughout treatment, according to the American Heart Association 1

For pediatric patients, the same glucose threshold applies, adding 5% dextrose to 0.45-0.75% NaCl when glucose reaches 250 mg/dL, with a maintenance rate of approximately 100 mL/kg per 24 hours (7 mg/kg per minute) for 10% dextrose 2, 3
The American Academy of Pediatrics recommends using 10% dextrose at a rate of 100 mL/kg per 24 hours (7 mg/kg per minute) for pediatric patients with euglycemic DKA or special circumstances 3