What is the first-line fluid in diabetic ketoacidosis and how is it administered?

What is the first-line fluid in diabetic ketoacidosis and how is it administered?

• A. 0.9% saline, 1 L in the first hour
• B. Lactated Ringer's solution, 1 L in the first hour
• C. 0.45% saline, 1 L in the first hour
• D. 5% dextrose in water immediately

Answer: (A)

In diabetic ketoacidosis the top priority is rapidly restoring intravascular volume because severe dehydration from osmotic diuresis impairs perfusion. An isotonic crystalloid is used so you replenish the circulating volume without shifting water into the cells or causing osmotic imbalances. The standard first step is to give a liter of 0.9% sodium chloride in the first hour to quickly expand blood volume and improve tissue perfusion. After that initial bolus, you continue fluids based on the patient’s hydration status, corrected sodium, and blood pressure, and you start insulin therapy once volume status is being maintained and potassium is accounted for. You switch to fluids with dextrose when glucose drops to around 200 mg/dL to prevent hypoglycemia while treatment continues. Lactated Ringer’s can be used in some settings, but many guidelines and exams treat normal saline as the first-line choice. Starting with 0.45% saline or with dextrose-containing fluids right away would not adequately address the urgent volume deficit.

In diabetic ketoacidosis the top priority is rapidly restoring intravascular volume because severe dehydration from osmotic diuresis impairs perfusion. An isotonic crystalloid is used so you replenish the circulating volume without shifting water into the cells or causing osmotic imbalances. The standard first step is to give a liter of 0.9% sodium chloride in the first hour to quickly expand blood volume and improve tissue perfusion. After that initial bolus, you continue fluids based on the patient’s hydration status, corrected sodium, and blood pressure, and you start insulin therapy once volume status is being maintained and potassium is accounted for. You switch to fluids with dextrose when glucose drops to around 200 mg/dL to prevent hypoglycemia while treatment continues. Lactated Ringer’s can be used in some settings, but many guidelines and exams treat normal saline as the first-line choice. Starting with 0.45% saline or with dextrose-containing fluids right away would not adequately address the urgent volume deficit.