🏥 USMLE Exam Prep

A 28-year-old female presents to the emergency department with polyuria, polydipsia, and altered mental status. Laboratory results reveal glucose 550 mg/dL, pH 7.18, bicarbonate 10 mEq/L, and an anion gap of 22. Urinalysis shows moderate ketones. Her blood pressure is 90/60 mmHg. What is the most appropriate initial fluid resuscitation strategy?

A 0.9% Normal Saline at 1 L/hour
B D5W at 100 mL/hour
C 0.45% Normal Saline at 250 mL/hour
D Lactated Ringer's at 500 mL/hour

✓ Correct Answer: Option A

Initial management of DKA, especially in hypotensive patients, involves aggressive volume repletion with 0.9% Normal Saline (isotonic crystalloids) to restore intravascular volume and improve renal perfusion.

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