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First step in diabetic ketoacidosis
Medicine · exam-style practice question with explanation
A 19-year-old with type 1 diabetes has diabetic ketoacidosis with dehydration. What is the most important first step in management?
- A. Intravenous sodium bicarbonate
- B. Intravenous fluids (0.9% sodium chloride)
- C. Subcutaneous long-acting insulin
- D. Oral potassium supplements
Show the answer and explanation
Answer: B. Intravenous fluids (0.9% sodium chloride)
Fluid resuscitation with 0.9% sodium chloride comes first in DKA, because patients are severely dehydrated. A fixed-rate intravenous insulin infusion follows, with close potassium monitoring and replacement. Bicarbonate is rarely needed.
Key point: DKA: fluids first, then fixed-rate IV insulin; watch potassium.
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