Initial fluid therapy for suspected diabetic ketoacidosis is which?

• A. 0.9% Normal saline
• B. 0.45% saline
• C. Lactated Ringer's
• D. Dextrose-containing solution

Answer: (A)

In suspected diabetic ketoacidosis, the priority is to rapidly restore intravascular volume to improve tissue perfusion and renal function, which underpins safe insulin therapy and correction of electrolyte abnormalities. An isotonic fluid is best for this initial resuscitation because it expands the extracellular fluid without causing dangerous shifts between compartments. Normal saline fits this role because it stays in the extracellular space and corrects dehydration and hypotension effectively.

Using a hypotonic solution early would risk worsening volume depletion, while a dextrose-containing fluid isn’t started yet because the goal is to lower glucose and correct acidosis with insulin first, not to provide calories. Dextrose-containing fluids are brought in later, once the glucose level has fallen to around 200–250 mg/dL, to prevent hypoglycemia while continuing insulin.

Lactated Ringer’s can be used in some settings, but it’s not the standard initial choice in many protocols due to its lactate and potassium content, which may complicate early electrolyte management.