In the management of DKA, what should be administered if potassium is less than 3.3 mEq/L?

In the management of diabetic ketoacidosis (DKA), if potassium levels are found to be less than 3.3 mEq/L, it is crucial to administer potassium. This is because insulin therapy, which is central to the treatment of DKA, can drive potassium into the cells, worsening the hypokalemia. Administering potassium helps to restore normal serum levels and prevents complications associated with low potassium, such as cardiac arrhythmias.

Moreover, prior to initiating insulin treatment in a patient with critically low potassium, it is essential to correct the hypokalemia. This immediate correction is important to ensure safe management of the patient and to avoid exacerbating electrolyte imbalances. Ensuring that potassium levels are adequate also allows for the effective continuation of DKA treatment with insulin once the potassium is normalized.

In contrast, the other options would not adequately address the immediate risk posed by the low potassium levels. Insulin would further lower serum potassium, bicarbonate is not routinely indicated in DKA unless specific conditions warrant it, and normal saline is primarily used for volume resuscitation rather than specifically targeting potassium levels. Therefore, potassium administration is the appropriate intervention when levels are critically low to ensure the patient's safety during DKA management.