What type of fluid is initially administered for fluid resuscitation in DKA management during pregnancy?

In the management of diabetic ketoacidosis (DKA) during pregnancy, the initial fluid resuscitation is typically carried out with 0.9% sodium chloride (NaCl), commonly referred to as normal saline. This isotonic solution is effective for rehydrating the patient and restoring intravascular volume. In the context of DKA, there is often significant dehydration due to osmotic diuresis, hence the need for rapid rehydration.

Normal saline provides not only adequate volume but also helps expand the extracellular fluid compartment, which is crucial for correcting the deficits associated with dehydration. Furthermore, the use of isotonic saline helps avoid complications that can arise from changing serum sodium levels, as more hypotonic solutions may lead to a rapid decrease in serum osmolality.

Additionally, normal saline does not contain glucose, making it ideal for a scenario where the patient is in an insulin-deficient state, as giving dextrose could exacerbate hyperglycemia and possibly worsen ketoacidosis. Thus, the choice of normal saline aligns with the primary goals of fluid resuscitation in DKA management—rehydration and stabilization of electrolytes without aggravating the underlying hyperglycemic state.