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DKA Initial Fluid Management — FRCA Final MCQ

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ModerateIntensive Care MedicineDKA Initial Fluid ManagementFRCA Final

A patient is admitted to ICU with diabetic ketoacidosis. pH 7.05, K+ 5.8, glucose 42 mmol/L. The initial fluid bolus should be:

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Correct answer: A — 0.9% NaCl 500 mL over 15 minutes

DKA initial management (JBDS 2023): IV fluid FIRST (0.9% NaCl 500 mL/15 min if SBP <90, or 1L/1h). Fixed-rate insulin infusion (0.1 U/kg/h) started concurrently but fluid is the priority — many patients respond significantly to fluid alone. Despite K+ 5.8, potassium will fall rapidly with insulin and must be monitored hourly and replaced when <5.5.

Reference: JBDS – 2023 – Management of DKA in adults