In diabetic ketoacidosis, name three common laboratory abnormalities and the initial fluid therapy approach.

• A. Hypoglycemia, metabolic alkalosis, hypokalemia; begin hypotonic fluids and avoid electrolytes
• B. Hyperglycemia, metabolic acidosis with high anion gap, hyperkalemia; begin isotonic crystalloids and correct electrolytes, monitor glucose and potassium
• C. Hyperglycemia, metabolic alkalosis, hyponatremia; no fluids
• D. Hypoglycemia; mild dehydration; monitor only

Answer: (B)

Restoring circulation and correcting electrolyte disturbances are the first priorities in diabetic ketoacidosis. In this condition you typically see very high blood glucose, a metabolic acidosis with a high anion gap from accumulating ketoacids, and a potassium imbalance that can appear as hyperkalemia at first even though the total body potassium is depleted from body losses. The initial fluid approach is to give isotonic crystalloids to rehydrate and improve tissue perfusion—most often starting with normal saline. At the same time, electrolytes are corrected and potassium is monitored closely because insulin therapy and fluid therapy can drive potassium into cells, risking a drop in serum K+. The plan is to replace potassium as needed to maintain safe levels while continuing to correct the acidosis and hyperglycemia. As glucose falls and you start moving toward insulin therapy, you’ll typically add dextrose-containing fluids to allow continued insulin administration without causing hypoglycemia, all while continuing electrolyte monitoring and adjustments. This pattern—hyperglycemia, high-anion-gap metabolic acidosis, potassium imbalance, and isotonic fluid resuscitation with coordinated electrolyte management—best matches the correct approach.