What is the initial fluid selection for an adult patient with diabetic ketoacidosis (DKA)?

The initial fluid selection for an adult patient with diabetic ketoacidosis (DKA) is 0.9% saline. This isotonic solution is crucial for rehydrating the patient and addressing the volume depletion that often occurs in DKA due to hyperglycemia and osmotic diuresis.

When managing DKA, the primary goals include correcting dehydration and restoring circulatory volume before addressing the hyperglycemia more directly with insulin administration. The use of 0.9% saline helps to rapidly replenish intravascular volume, which can improve kidney perfusion, facilitate the clearance of ketones, and help stabilize the patient's overall condition.

Other solutions, such as lactated Ringer’s solution, while they provide additional electrolytes, may not be the most immediate choice for fluid resuscitation in DKA due to differing effects on osmolality. Dextrose solutions, including 5% dextrose in saline, could potentially exacerbate hyperglycemia and should be avoided until blood glucose levels are stabilized as part of the DKA treatment protocol. Similarly, 0.45% saline, being hypotonic, is not suitable for initial resuscitation in DKA because it does not adequately address the deficits in intravascular volume