In diabetic ketoacidosis, when should fluids be changed from normal saline to dextrose-containing fluids?

• A. When blood glucose approaches 200 mg/dL
• B. When glucose reaches 400 mg/dL
• C. Immediately after starting treatment
• D. After 24 hours regardless of glucose

Answer: (A)

In treating diabetic ketoacidosis, you continue insulin to shut down ketone production and correct acidosis, while fluids support circulation and electrolyte balance. Switch from normal saline to dextrose-containing fluids when blood glucose falls to about 200 mg/dL. This threshold prevents hypoglycemia as insulin therapy continues, while still allowing ongoing insulin to correct ketoacidosis and glucose toward a safe range. Delaying the switch until glucose is higher would risk hyperglycemia persisting, and switching too early would complicate management since insulin should still be given to resolve the metabolic derangements.