In managing DKA in pregnancy, what is the recommended initial fluid therapy within the first 12 hours?

The recommended initial fluid therapy for managing diabetic ketoacidosis (DKA) in pregnancy is primarily geared towards ensuring adequate hydration and restoring electrolyte balance while also considering the safety of both the mother and the fetus. Within the first 12 hours of treatment, the use of 4-6 liters of normal saline (NS) is advised.

Normal saline is isotonic and effectively increases intravascular volume, helping to address the dehydration that often accompanies DKA. This approach not only aids in correcting hyperglycemia but also promotes renals' ability to excrete excess ketones. Further, it is crucial to monitor the patient's response, electrolytes, and hemodynamics closely during fluid resuscitation.

Other fluids mentioned, such as D5W or hypertonic saline, are not suitable initial treatments for DKA in pregnancy. D5W is isotonic until it metabolizes, at which point it becomes hypotonic, potentially worsening hyperglycemia. Lactated Ringer's, while useful in certain contexts, does not have the same level of established use in DKA management as normal saline does in this maternal-fetal clinical scenario.