What is the typical initial step in managing a patient presenting with severe DKA?

The typical initial step in managing a patient presenting with severe diabetic ketoacidosis (DKA) is to give fluids. Dehydration is a critical concern in DKA, as patients often present with significant fluid loss due to osmotic diuresis and can have depleted intravascular volume. Administering intravenous fluids helps to restore hydration, improve renal perfusion, and facilitate the clearance of glucose and ketones from the body.

Once fluid resuscitation is underway, insulin therapy can be initiated to address hyperglycemia and further reduce ketogenesis. While electrolyte replacement is also essential—especially potassium, given the risks of hypokalemia with insulin treatment—it is primarily considered after adequate fluid resuscitation. Intensive care transfer may be warranted in severe cases, but the immediate focus in emergency management should always start with correcting fluid deficits. This foundational step is crucial for stabilizing the patient before progressing to the other components of DKA management.