Water and Salt

Intravenous fluids are initiated to maintain and restore capillary perfusion. The first 1 to 2 L should be normal saline (NS), which is the best crystalloid volume expander. The rate of infusion depends on the patient's age and size. An otherwise healthy adolescent or young adult can tolerate 1 L/hr for 2 hours, but this will require clinical evaluation and judgment based on severity of presentation and patient response. A prompt urinary response to the first liter of NS ensures the safety of replacing potassium from the onset. Simply administering water and electrolytes will not turn off DKA but will help reverse the hyperosmolar state.

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