What is the first critical step in managing DKA or HHS?

Starting IV fluids is the first critical step in managing diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) because it addresses the severe dehydration commonly present in these conditions. Both DKA and HHS often result from prolonged hyperglycemia, which leads to osmotic diuresis and significant fluid loss. By initiating IV fluid therapy, healthcare providers aim to restore intravascular volume, improve tissue perfusion, and help facilitate the clearance of glucose.

The administration of insulin, while crucial, is typically not initiated until after fluid resuscitation begins, particularly because insulin can lead to rapid shifts in electrolytes and potentially worsen dehydration if fluids are not given first. Monitoring potassium levels, although important in DKA management, comes after ensuring adequate fluid resuscitation since potassium levels may change significantly during the treatment. Checking blood glucose levels is essential for diagnosis and management but does not address the immediate physiological needs of the patient experiencing severe hyperglycemic crises. Thus, fluid resuscitation is prioritized to stabilize the patient initially.