American Board of Internal Medicine (ABIM) Certification Practice Exam

At what glucose level in DKA should D5 be added to intravenous fluids?

1. 200

2. 250

3. 300

4. 350

The correct answer is: 250

In the management of diabetic ketoacidosis (DKA), the addition of dextrose (D5) to intravenous fluids is considered when the blood glucose level falls to around 250 mg/dL. The rationale behind this practice is to prevent hypoglycemia while still effectively treating the acidosis and hyperglycemia associated with DKA. As insulin therapy is initiated in DKA management, blood glucose levels typically decrease. If glucose levels drop too low without sufficient dextrose supplementation, there is a risk of hypoglycemia, which can lead to serious complications. Starting D5 when glucose levels reach 250 mg/dL helps maintain appropriate glucose levels without interfering with the treatment of ketoacidosis. This level is often chosen because it represents a point at which the glucose levels are being adequately addressed, but still have some buffer to avoid falling into hypoglycemic territory during insulin therapy. Recognizing the nuances in DKA management ensures that practitioners can provide safe and effective treatment while monitoring the patient's clinical status closely. The decision to add dextrose during fluid administration is part of a comprehensive approach to effectively manage DKA.