Fluid resuscitation with IV normal saline is the initial priority in diabetic ketoacidosis (DKA) to correct dehydration and improve tissue perfusion. Typical deficit is 6-10 liters. Protocol usually: 1-2 liters in first hour, then 200-500 mL/hour based on response. Concurrently: regular insulin infusion (after potassium >3.3 mEq/L); electrolyte replacement (especially potassium and phosphate); monitor blood glucose hourly; assess for cerebral edema (headache, confusion, coma - particular risk in children); identify and treat precipitating cause (infection most common). DKA features: hyperglycemia, ketosis, metabolic acidosis. Nursing assessments: vital signs; mental status; breath for fruity odor (acetone); signs of infection; and laboratory values (glucose, electrolytes, ABGs, ketones). Patient education focuses on sick day rules: continue insulin; check blood glucose frequently; monitor ketones; maintain hydration; and when to seek help. Prevention through education is key.

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Zambia

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