A patient with type 1 diabetes presents with Kussmaul respirations and acetone breath. What is the priority intervention?

• A. Begin IV fluids with isotonic saline and start insulin therapy per protocol.
• B. Administer subcutaneous insulin before fluids.
• C. Administer diuretics to reduce osmotic diuresis.
• D. Obtain ABG and wait for labs before starting therapy.

Answer: (A)

In this scenario, the priority is to stabilize the patient by correcting volume depletion and initiating rapid metabolic control. Diabetic ketoacidosis causes severe dehydration and impaired perfusion, along with ongoing ketone production and acidosis. Starting IV fluids with isotonic saline re expands intravascular volume, improves organ perfusion, and sets the stage for insulin to be effective. Insulin therapy should be started per protocol after fluids are begun to safely halt ketogenesis and reduce hyperglycemia and acidosis. Subcutaneous insulin is not ideal in the acute DKA setting because IV insulin provides rapid, controlled correction. Diuretics won’t address the underlying dehydration or acidosis, and delaying treatment for ABG results could worsen the patient’s condition. Therefore, beginning isotonic IV fluids and IV insulin per protocol is the appropriate action.