What is the initial treatment for a child presenting with diabetic ketoacidosis (DKA)?

The initial treatment for a child presenting with diabetic ketoacidosis (DKA) primarily involves the administration of an intravenous fluid bolus. This step is crucial because children with DKA are typically severely dehydrated due to osmotic diuresis caused by elevated blood glucose levels. Administering IV fluids helps to restore intravascular volume, improve renal perfusion, and promote the excretion of ketones and glucose, all of which are vital in stabilizing the patient’s condition.

Starting with the correct type and volume of fluid is essential, often beginning with isotonic saline, which helps not only in hydration but also in correcting electrolyte imbalances, particularly addressing hypernatremia and acidosis. This initial fluid management lays the foundation for subsequent treatments, including insulin administration to lower blood glucose levels and correct metabolic derangements.

Other options, while relevant in the management of DKA, do not address the immediate need for fluid resuscitation that is fundamental during the initial phase of treatment. Oral rehydration therapy may not be feasible in an acute setting, especially if the child is vomiting or severely dehydrated. An immediate insulin bolus is not typically recommended until the patient is adequately hydrated and the initial fluid resuscitation is underway. Glucose