Why is IV dextrose given to patients with DKA?
When the serum glucose reaches 200 mg/dL in a patient with diabetic ketoacidosis (DKA), IV dextrose is added to avoid the development of cerebral edema. In addition, the rate of insulin infusion may need to be slowed down to between 0.02 and 0.05 units/kg/hr. Overly rapid correction of blood glucose past this point may cause a rapid reduction in effective serum osmolarity, reverse the fluid shift that occurs in DKA, and result in the development of cerebral edema. The goal is to slow the rate of glucose decline and avoid promoting the development of cerebral edema.
There is an exception to the rule of waiting until the serum glucose reaches 200 mg/dL to add dextrose. If a patient has euglycemic DKA, they will still need insulin treatment to resolve the ketoacidosis. Without dextrose, they will develop hypoglycemia. Therefore in euglycemic DKA, dextrose is added to insulin at the start of treatment.
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