Which intravenous fluid is recommended in alcoholic ketoacidosis?

Which intravenous fluid is recommended in alcoholic ketoacidosis?

• A. Lactated Ringer's
• B. Normal saline
• C. D5W
• D. D5NS

Answer: (D)

Alcoholic ketoacidosis involves dehydration with a high anion-gap acidosis from ketone production. The treatment focuses on restoring volume and providing glucose to suppress ongoing ketogenesis. A fluid that does both—providing isotonic volume and supplying dextrose—is most effective early in management. Five percent dextrose in normal saline delivers isotonic fluid to rehydrate and correct electrolyte losses, while the dextrose supplies energy and triggers insulin release to stop lipolysis and ketone production. This helps resolve the metabolic acidosis as ketogenesis subsides. It also avoids introducing a lactate load that could complicate acidosis in a patient who may have hepatic alcohol-related injury, which makes lactated solutions less ideal. Other options have drawbacks: lactated Ringer's adds lactate, which can accumulate when liver function is impaired; dextrose-containing fluids without electrolytes risk ongoing electrolyte disturbances and hyponatremia if not balanced; plain normal saline provides volume but lacks glucose to curb ketosis.

Alcoholic ketoacidosis involves dehydration with a high anion-gap acidosis from ketone production. The treatment focuses on restoring volume and providing glucose to suppress ongoing ketogenesis. A fluid that does both—providing isotonic volume and supplying dextrose—is most effective early in management.

Five percent dextrose in normal saline delivers isotonic fluid to rehydrate and correct electrolyte losses, while the dextrose supplies energy and triggers insulin release to stop lipolysis and ketone production. This helps resolve the metabolic acidosis as ketogenesis subsides. It also avoids introducing a lactate load that could complicate acidosis in a patient who may have hepatic alcohol-related injury, which makes lactated solutions less ideal.

Other options have drawbacks: lactated Ringer's adds lactate, which can accumulate when liver function is impaired; dextrose-containing fluids without electrolytes risk ongoing electrolyte disturbances and hyponatremia if not balanced; plain normal saline provides volume but lacks glucose to curb ketosis.