When should dextrose be added to IV fluids for a DKA patient?

In the management of diabetic ketoacidosis (DKA), the addition of dextrose to IV fluids is crucial when serum glucose levels drop below 250 mg/dL. This is because, during the treatment of DKA, insulin is administered to lower blood glucose levels and promote the metabolism of ketones. However, insulin can cause blood glucose levels to decrease rapidly, potentially leading to hypoglycemia.

By adding dextrose when the serum glucose is less than 250 mg/dL, the risk of hypoglycemia is mitigated while still allowing for continued management of acidosis and ketone levels. This approach ensures that the patient receives adequate glucose to maintain safe serum levels, preventing complications associated with overly rapid declines in glucose.

It is important to monitor serum glucose closely in patients receiving treatment for DKA and to adjust fluid composition accordingly. Maintaining a target glucose level, rather than allowing it to fall too low, is critical in the overall management and recovery of the patient.