In the acute phase of diabetic ketoacidosis, what is the priority nursing action?

• A. Correct the acidosis.
• B. Administer IV 5% dextrose.
• C. Administer intravenous regular insulin.
• D. Apply an ECG monitor.

Answer: (C)

In the acute phase of diabetic ketoacidosis, the most urgent need is to restore circulating volume. Severe dehydration from osmotic diuresis compromises perfusion to vital organs and kidney function, so initiating rapid IV isotonic saline rehydration is the top priority to stabilize the patient. Insulin therapy is essential to stop ketone production and correct acidosis, but it is started after initial fluid resuscitation and after assessing potassium because insulin drives potassium into cells and can precipitate dangerous hypokalemia if not carefully timed and monitored. While ECG monitoring and planning for later transitions to dextrose-containing fluids are important, they’re not the immediate first action.