ZyraDoc #04 - August 06, 2026

A 22-year-old woman with type 1 diabetes presents with nausea, abdominal pain, and Kussmaul respiration.

She is diagnosed with severe diabetic ketoacidosis (DKA) and started on IV fluid resuscitation and regular insulin infusion.

Six hours later, her blood glucose drops to 180 mg/dL, but her anion gap remains elevated at 22 mEq/L with persistent ketonemia.

Case Summary

Clinical Focus:

A 22-year-old female undergoing active protocolized treatment for severe diabetic ketoacidosis (DKA) achieves glycemic reduction (< 200 mg/dL), but exhibits persistent metabolic ketoacidosis and an elevated anion gap.

How to know if there is complete resolution of Diabetic Ketoacidosis:

Blood glucose < 200 mg/dL
Serum bicarbonate ≥ 18 mEq/L and venous pH > 7.30
Anion gap normalized (≤ 12 mEq/L)
Complete clearance of serum ketoacids and restoration of oral intake

When blood glucose normalizes before systemic metabolic acidosis and ketoacidosis have fully resolved, premature cessation of IV insulin leads to severe rebound ketoacidosis.

Here is the Management Strategy:

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