What is the first step in the treatment of diabetic ketoacidosis (DKA)?

The first step in the treatment of diabetic ketoacidosis (DKA) is volume expansion with intravenous fluids. DKA is characterized by hyperglycemia, metabolic acidosis, and ketones in the urine, which can lead to significant dehydration due to osmotic diuresis. Patients often present with elevated blood glucose levels and may have lost a considerable amount of fluid and electrolytes.

Administering intravenous fluids is crucial because it helps to restore circulating volume, improve renal perfusion, and dilute serum glucose levels. This initial volume resuscitation is essential before any other interventions, such as insulin therapy, can be effectively implemented. Once the patient is adequately hydrated, insulin can be administered to lower blood glucose levels and reverse the metabolic derangements.

In the case of checking serum electrolytes, while monitoring electrolytes is important in managing DKA, it is not the immediate first step. Bicarbonate administration is generally reserved for severe cases of acidosis and is not a routine part of DKA treatment unless the pH is extremely low. Therefore, the primary focus must be on rehydration before any other specific treatments are initiated.