In an old cat with diabetic ketoacidosis (DKA), what is the first treatment recommended to address severe acidosis?

In the management of an old cat with diabetic ketoacidosis (DKA), the initial step to address severe acidosis is fluid therapy, particularly with isotonic fluids such as 0.9% NaCl. The primary goal of fluid therapy in this context is to restore hydration status and improve renal perfusion, which can help facilitate the resolution of acidosis and the underlying metabolic disturbances associated with DKA.

When a cat with DKA is dehydrated, which is common due to osmotic diuresis from elevated blood glucose levels, administering fluids helps to dilute acids in the bloodstream and supports the kidneys in excreting these acids. It also rehydrates the patient, correcting electrolyte imbalances and stabilizing blood pressure, which are crucial for the effective treatment of DKA.

While insulin therapy is vital for lowering blood glucose and resolving ketosis, initiating insulin before addressing fluid deficits can lead to a rapid decrease in glucose levels without adequate hydration, resulting in further complications. Potassium supplementation may be necessary as DKA treatment progresses, especially since insulin administration can cause shifts in potassium levels. Bicarbonate administration is generally reserved for severe acidosis with significant clinical signs and is not typically the first-line treatment due to potential complications and its limited effect on the underlying