Which IV fluids are typically used to address fluid deficit in DKA/HHS?

Which IV fluids are typically used to address fluid deficit in DKA/HHS?

• A. Lactated Ringer's solution only
• B. Hypotonic saline
• C. Normal saline and D5W
• D. Dextrose solutions only

Answer: (C)

In DKA and HHS, the first priority is to restore circulating volume because dizziness, tachycardia, and poor perfusion come from profound fluid deficit caused by osmotic diuresis. The fluid of choice for this initial resuscitation is normal saline (0.9% NaCl) because it is isotonic and expands the intravascular compartment without creating rapid shifts in serum osmolality. As insulin therapy corrects hyperglycemia and the patient’s perfusion improves, you shift to fluids that also provide dextrose to prevent hypoglycemia and supply calories. Dextrose-containing fluids are started when blood glucose falls to roughly 200–250 mg/dL in DKA (and around 300 mg/dL in HHS); a dextrose solution such as D5W is used in combination with continued insulin to complete metabolic correction while maintaining circulation. This combination—normal saline initially for volume, then dextrose-containing fluids like D5W to prevent hypoglycemia—best addresses both the fluid deficit and the evolving metabolic needs.

In DKA and HHS, the first priority is to restore circulating volume because dizziness, tachycardia, and poor perfusion come from profound fluid deficit caused by osmotic diuresis. The fluid of choice for this initial resuscitation is normal saline (0.9% NaCl) because it is isotonic and expands the intravascular compartment without creating rapid shifts in serum osmolality. As insulin therapy corrects hyperglycemia and the patient’s perfusion improves, you shift to fluids that also provide dextrose to prevent hypoglycemia and supply calories. Dextrose-containing fluids are started when blood glucose falls to roughly 200–250 mg/dL in DKA (and around 300 mg/dL in HHS); a dextrose solution such as D5W is used in combination with continued insulin to complete metabolic correction while maintaining circulation. This combination—normal saline initially for volume, then dextrose-containing fluids like D5W to prevent hypoglycemia—best addresses both the fluid deficit and the evolving metabolic needs.