An adult patient is undergoing treatment in the intensive care unit for diabetic ketoacidosis. Initial therapy with a continuous intravenous insulin infusion and fluid resuscitation has been established. Arrange the following monitoring, treatment adjustment, and de-escalation steps in the standard chronological sequence required to safely resolve the episode and transition the patient to a subcutaneous maintenance regimen.
- 1Monitor capillary blood glucose hourly and serum electrolytes every 2 to 4 hours
- 2Add 5% dextrose to the intravenous fluid composition when blood glucose decreases to 200 mg/dL
- 3Confirm resolution of ketoacidosis by documenting a normalized anion gap and venous pH greater than 7.3
- 4Administer the first dose of subcutaneous basal insulin
- 5Discontinue the continuous intravenous insulin infusion 1 to 2 hours after the subcutaneous injection
Answer
The correct sequence is: establish frequent biochemical monitoring, add dextrose when glucose reaches 200 mg/dL, confirm biochemical resolution via the anion gap, administer subcutaneous basal insulin, and finally discontinue the intravenous insulin infusion 1 to 2 hours later.
This sequence represents the widely tested, universal protocol for managing and safely de-escalating therapy in diabetic ketoacidosis. Frequent monitoring ensures safety, adding dextrose allows insulin to run until the gap closes, checking the gap confirms resolution, and overlapping the subcutaneous dose prevents rebound.
Step-by-Step Solution
Key Concept
The standard protocol for diabetic ketoacidosis resolution requires adding dextrose before stopping insulin, confirming anion gap closure, and ensuring an overlap period between subcutaneous insulin administration and intravenous insulin discontinuation.