What is the initial treatment protocol for an adult with blood glucose over 300 mg/dL showing DKA signs?

In cases of diabetic ketoacidosis (DKA), a critical component of the initial treatment protocol involves addressing dehydration and ensuring adequate intravascular volume. When an adult presents with elevated blood glucose levels over 300 mg/dL and shows signs of DKA, the administration of normal saline is essential for several reasons.

First, DKA is often accompanied by significant fluid loss due to osmotic diuresis, which can lead to severe dehydration. Administering 1 liter of normal saline helps restore intravascular volume and correct electrolyte imbalances, particularly sodium and potassium levels, which can be disrupted in this condition.

While insulin is an important part of managing DKA, it should not be administered before fluid resuscitation because insufficient circulating volume may lead to complications such as hypotension or renal failure. Bicarbonate therapy is generally not recommended in the initial treatment of DKA unless the patient is severely acidotic (pH less than 6.9), as it does not address the underlying cause of DKA and may cause electrolyte shifts and affect oxygen delivery to tissues. An immediate blood transfusion is not indicated in this scenario unless there are specific signs of hemorrhagic shock or severe anemia, which are not characteristic of DKA.