Professional and Linguistic Assessments Board (PLAB) Practice Exam

In treating DKA, what is the initial fluid of choice for patients with blood pressure above 90?

1. 1% NaCl

2. 0.9% NaCl 60 mins

3. 3% Saline

4. D5W

The correct answer is: 0.9% NaCl 60 mins

The initial fluid of choice for treating diabetic ketoacidosis (DKA) in patients with a blood pressure above 90 mmHg is 0.9% NaCl (normal saline). This isotonic solution is essential for rehydrating the patient and restoring extracellular volume when dealing with DKA, which often presents with significant dehydration due to osmotic diuresis. Normal saline is effective in addressing hypovolemia and helps to improve renal perfusion, which is critical for the excretion of ketones and glucose. The administration of normal saline also assists in correcting electrolyte imbalances that may have developed due to DKA. Moreover, the use of normal saline helps to stabilize blood pressure and ensure adequate circulatory volume, which is particularly important in the management of any critically ill patients, including those presenting with DKA. The recommendation for an initial bolus of normal saline over a specific timeframe facilitates continuous monitoring of the patient’s hydration status and hemodynamic stability. In contrast, other solutions such as 3% saline are hypertonic and are generally reserved for specific cases of hyponatremia rather than as the first-line treatment in DKA scenarios. D5W is a dextrose solution that is not suitable for