What is the primary treatment for diabetic ketoacidosis (DKA) in adults?

• A. Oral glucose tablets only.
• B. Fluid replacement with isotonic saline, IV insulin, electrolyte management.
• C. Immediate dialysis.
• D. Observation without insulin.

Answer: (B)

The essential approach to this scenario is addressing dehydration, insulin deficiency, and the electrolyte disturbances driving the metabolic acidosis in diabetic ketoacidosis. The best answer describes fluid replacement with isotonic saline to restore intravascular volume and perfusion, intravenous insulin to halt ketone production and drop glucose and acidosis, and careful electrolyte management to correct potassium and other imbalances as treatment progresses.

Fluid resuscitation with isotonic saline is started first to reverse dehydration and improve tissue perfusion, which is critical in DKA where volume depletion is common. As insulin is infused, blood glucose falls and ketone production stops, helping correct the metabolic acidosis. But insulin also drives potassium into cells, which can precipitate dangerous hypokalemia, so simultaneous electrolyte monitoring and replacement—especially potassium—is essential. Dextrose is added later to prevent hypoglycemia once blood glucose nears-normal ranges.

Other options don’t address the underlying problems: oral glucose tablets won’t correct the severe dehydration or metabolic acidosis, dialysis isn’t the immediate treatment for DKA, and simply observing without insulin allows the dangerous metabolic process to continue.