What would be the first-line electrolytic correction in a DKA patient?

The first-line electrolytic correction in a patient with diabetic ketoacidosis (DKA) is potassium replacement if the serum potassium level is low. In DKA, hyperglycemia leads to osmotic diuresis, which can result in significant potassium loss through urine. Even though many patients present with a normal or elevated serum potassium level due to the shifts of potassium from intracellular to extracellular compartments (driven by acidosis), total body potassium is often depleted.

During the treatment of DKA, insulin therapy is initiated to lower blood glucose levels. Insulin drives potassium back into cells, potentially leading to hypokalemia if potassium is not replaced adequately. Therefore, it is crucial to monitor potassium levels regularly and replace potassium if it is found to be low or if there is a risk of it becoming low during treatment.

Other options, while they may play roles in the management of patients with electrolyte imbalances, are not first-line therapies specific to correcting the electrolyte disturbances seen in DKA. Sodium correction with hypertonic saline addresses specific hyponatremia but is not a routine first-line intervention in DKA. Calcium and magnesium supplementation are generally reserved for specific deficiencies rather than being standard initial corrections in DKA management.