In the treatment of DKA, what is the role of fluids?

• A. Fluids only after insulin therapy.
• B. Rehydrate the patient to correct dehydration and support circulation.
• C. Avoid fluids to prevent edema.
• D. Only give electrolyte solutions without glucose.

Answer: (B)

During DKA, there is substantial fluid loss from osmotic diuresis and vomiting, leading to dehydration and reduced circulating volume. Rehydration with isotonic fluids right away is essential to restore intravascular volume, improve tissue and renal perfusion, and support blood pressure so insulin can be given safely and the metabolic derangements can begin to resolve. Fluids are started before insulin for this reason, and the regimen is adjusted as the patient stabilizes—switching the type or rate based on corrected sodium and under glucose control, with dextrose-containing fluids added when blood glucose falls to about 200 mg/dL to allow ongoing insulin therapy without causing hypoglycemia. It’s not about avoiding fluids or giving only electrolyte solutions; restoring volume is a foundational step in DK A treatment and underpins effective management.