A client is diagnosed with diabetic ketoacidosis. The nurse should be prepared to administer which of the following IV solutions?

The initial management of diabetic ketoacidosis (DKA) focuses on correcting severe dehydration, hyperglycemia, and electrolyte imbalances. Profound fluid loss occurs due to osmotic diuresis. Therefore, the immediate priority is aggressive intravenous fluid resuscitation to restore intravascular volume and improve tissue perfusion. Isotonic saline (0.9% normal saline) is the standard fluid of choice for initial rehydration. It rapidly expands the extracellular fluid volume, helps lower blood glucose by increasing glomerular filtration rate, and begins to correct electrolyte deficits. Dextrose-containing solutions are contraindicated initially as they would worsen the severe hyperglycemia characteristic of DKA.

A. D5 in normal saline: This solution contains dextrose, which is inappropriate for a client with severe hyperglycemia and would worsen their condition.

B. D5W: This solution contains dextrose and becomes hypotonic in the body, which is not effective for rapid intravascular volume expansion needed in DKA.

D. D5 in lactated Ringer’s: This solution also contains dextrose, which is contraindicated in the initial treatment phase of DKA due to severe hyperglycemia.

1. Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, 32(7), 1335–1343. https://doi.org/10.2337/dc09-9032. (In the "Fluid Therapy" section, the guideline states, "The initial fluid of choice is 0.9% NaCl, infused at a rate of 15–20 ml · kg−1 · h−1 or 1–1.5 L during the first hour." p. 1337).

2. Harding, M. M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems (11th ed.). Elsevier. (In Chapter 48, Diabetes Mellitus, under the "Diabetic Ketoacidosis" section, the text specifies that initial fluid therapy begins with an infusion of 0.9% NaCl to restore urine output and raise blood pressure. p. 1121).

3. Gosmanov, A. R., Gosmanova, E. O., & Dillard-Cannon, E. (2014). Management of adult diabetic ketoacidosis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7, 255–264. https://doi.org/10.2147/DMSO.S50516. (The article's "Fluid replacement" section states, "The initial fluid of choice for volume resuscitation is isotonic saline (0.9% NaCl)." p. 257).