The best initial intervention for a child suspected of diabetic ketoacidosis is which of the following?

The best initial intervention for a child suspected of diabetic ketoacidosis (DKA) is to perform a random glucose test and provide an intravenous (IV) fluid bolus. DKA is a serious and potentially life-threatening condition that occurs primarily in children with type 1 diabetes, characterized by metabolic derangements resulting from insulin deficiency.

In the setting of suspected DKA, the priority is to confirm the diagnosis through blood glucose measurement. This helps to establish the hyperglycemic state, which is crucial for the management of the child. Once confirmation is obtained, initiating hydration with IV fluids is critical. Children with DKA often present with significant dehydration due to osmotic diuresis from hyperglycemia, leading to electrolyte imbalances and possible shock. Administering an IV fluid bolus helps to restore intravascular volume and improve circulation, which is vital for stabilizing the child’s condition.

While insulin therapy is an important component of managing DKA, it is not the first step. Insulin should be administered after hydration has begun, as it can precipitate further dehydration if started too early without addressing fluid status. Oral rehydration is typically insufficient in the setting of severe DKA, where rapid and effective rehydration is necessary.