A client is experiencing symptoms of fluid overload.
Which of the following interventions would the nurse anticipate as appropriate for this client?

Choice A reason: This hypotonic saline solution is often used after initial resuscitation, especially when the patient’s serum sodium is normal or elevated. It helps replace intracellular fluid losses and provides ongoing hydration without excessively increasing sodium levels. It is typically administered once the initial intravascular volume is restored with isotonic fluids.

Choice B reason: This isotonic saline solution is the first-line intravenous fluid used in DKA. It helps expand intravascular volume quickly, restore tissue perfusion, and correct hypovolemia caused by osmotic diuresis. It is given initially as a bolus, followed by continuous infusion until the patient is stabilized.

Choice C reason: This dextrose-containing solution is introduced once blood glucose falls to approximately 200–250 mg/dL. At this point, insulin therapy must continue to clear ketones and correct acidosis, but dextrose is added to prevent hypoglycemia. It is usually combined with saline (e.g., D5 0.45% NS) to balance hydration and glucose support.

Choice D reason: This balanced electrolyte solution is not typically the preferred fluid in DKA management because the lactate component may complicate interpretation of acid–base status. Although it can expand volume, it is generally avoided in favor of saline solutions that more directly address dehydration and electrolyte imbalance in DKA.

Choice E reason: This form of insulin is the only type used intravenously in DKA. A continuous infusion of regular insulin is essential to reduce blood glucose, suppress ketone production, and correct metabolic acidosis. It is carefully titrated with close monitoring of electrolytes, especially potassium, since insulin drives potassium into cells and can cause hypokalemia.

Fluid overload, also called hypervolemia, is a condition in which the body has too much water.

It can cause edema, hypertension, shortness of breath, and cardiovascular problems.

Diuretics are medications that help the body remove excess fluid through urine.

They are commonly used to treat fluid overload caused by heart failure, kidney failure, cirrhosis, and other conditions.

Choice B is wrong because encouraging increased fluid intake would worsen the fluid overload and increase the risk of complications.

Choice C is wrong because providing a high-sodium diet would also worsen the fluid overload and increase the risk of complications.

Sodium is an electrolyte that regulates fluid balance in the body.

Excess sodium intake can cause water retention and increase blood pressure.

Choice D is wrong because elevating the affected extremities is not an appropriate intervention for fluid overload.

Elevating the extremities can help reduce swelling caused by local factors such as injury or inflammation, but it does not address the underlying cause of fluid overload.