What is the initial treatment protocol for a patient with diabetic ketoacidosis?

The initial treatment protocol for a patient with diabetic ketoacidosis (DKA) primarily emphasizes two critical components: fluid resuscitation and insulin therapy. In DKA, patients present with hyperglycemia, ketonemia, and metabolic acidosis, which typically lead to significant dehydration and electrolyte imbalances.

Fluid resuscitation is essential to restore intravascular volume, improve renal perfusion, and help dilute glucose levels. This is achieved by administering isotonic saline, allowing for the correction of dehydration and normalization of blood pressure while also starting insulin therapy to address the underlying hyperglycemia and ketonemia.

Insulin therapy is crucial as it helps to reduce blood glucose levels, suppresses ketogenesis in the liver, and aids in correcting metabolic acidosis. It does so by promoting the uptake of glucose into cells, which is vital in reversing the metabolic derangements seen in DKA.

While insulin is a critical component of the treatment, administering it without initial fluid resuscitation could lead to complications such as further dehydration or worsening acute kidney injury, which can occur if renal perfusion is not adequately restored. Hence, the combination of fluid resuscitation and insulin therapy represents the best initial approach to managing DKA effectively.