What is the first step in the treatment of Diabetic Ketoacidosis (DKA) during pregnancy?

In the treatment of Diabetic Ketoacidosis (DKA) during pregnancy, the first and most crucial step is the administration of a fluid bolus. This is essential because patients with DKA often present with significant dehydration due to osmotic diuresis resulting from hyperglycemia. Administering fluids helps restore intravascular volume, correct electrolyte imbalances, and improve renal perfusion, which is vital for the excretion of ketones.

Fluid resuscitation typically begins with isotonic saline, which helps to quickly replenish fluids and supports the patient's hemodynamic status. Once hydration is initiated, subsequent management including insulin administration can follow, as insulin not only lowers blood glucose levels but also helps to halt ketogenesis.

While other treatments such as insulin administration and urinary catheterization are important in managing DKA, initiating treatment with fluid resuscitation is critical for stabilizing the patient and addressing the immediate complications of dehydration and electrolyte imbalances. Bicarbonate therapy is generally reserved for severe acidosis and is not a first-line treatment. Thus, fluid bolus is the foundation of immediate care in this setting.