What is the management strategy for DKA?

• A. Give only oral fluids and stop insulin.
• B. Correct dehydration, electrolyte loss, and acidosis; rehydrate with fluids; administer regular insulin; and monitor for fluid overload.
• C. Immediate surgery.
• D. Only monitor blood sugar and avoid fluids.

Answer: (B)

In DKA, the priority is to fix dehydration, electrolyte losses, and acidosis while preventing complications. Start with aggressive fluid replacement using isotonic saline to restore circulation and dilute ketones. As fluids are given and insulin is started, potassium shifts back into cells, so careful, ongoing potassium replacement is essential even if the initial potassium appears normal or high. Insulin therapy is then given to stop ketone production, lower blood glucose, and correct acidosis; this is usually delivered as a continuous IV infusion after initial fluid resuscitation and once potassium is being safely managed. When glucose falls to about 200 mg/dL, switch to dextrose-containing fluids so insulin can continue correcting ketosis without causing hypoglycemia. Bicarbonate is not routinely used; it’s reserved for very severe acidosis (very low pH). Throughout treatment, closely monitor vital signs, urine output, electrolytes (especially potassium), and risk of fluid overload or cerebral edema, adjusting therapy as needed.