What is the primary rationale for fluid administration in DKA management?

• A. To dilute blood glucose to normal levels.
• B. To rehydrate with fluids and restore perfusion, supporting electrolyte balance.
• C. To prevent insulin action.
• D. To worsen dehydration to stimulate kidneys.

Answer: (B)

Restoring circulating volume and tissue perfusion with isotonic fluids is the central aim of initial fluid therapy in DKA. When a patient develops DKA, osmotic diuresis causes substantial fluid loss, leading to dehydration and reduced kidney perfusion. Giving IV fluids quickly replenishes intravascular volume, improves blood flow to organs, and supports renal function so the kidneys can better excrete glucose and ketones and correct electrolyte imbalances. This fluid resuscitation also sets the stage for later insulin therapy, which is needed to correct hyperglycemia and acidosis; without adequate perfusion, insulin can be less effective and electrolyte disturbances can be worsened.

So the primary rationale is to rehydrate and restore perfusion, thereby stabilizing the patient and enabling proper electrolyte management and subsequent metabolic correction.