What is the initial fluid regimen for a patient in DKA?

The initial fluid regimen for a patient in diabetic ketoacidosis (DKA) typically involves administering a large volume of isotonic saline to restore intravascular volume and improve tissue perfusion. Administering 1 liter of normal saline in the first hour is recommended for rapid rehydration. This large initial bolus helps to counteract the dehydration that often accompanies DKA due to osmotic diuresis, where excess glucose in the blood spills into the urine and pulls water with it.

In DKA management, quick and effective rehydration is crucial as it can help lower blood glucose levels, correct electrolyte imbalances, and support renal function. The initial 1 liter bolus is a widely adopted protocol to quickly address the patient's fluid deficit.

Other options may not align with this standard protocol. For instance, administering 500 mL/hr would not provide the rapid volume expansion required initially, and while 2 liters in the first hour can be beneficial for certain patients, it may be excessive and could lead to complications like fluid overload. The maintenance rate option would not be appropriate as an initial strategy since it does not address the urgent need for rehydration.