In a 23-year-old woman with polyuria and polydipsia, glucose 520 mg/dL, positive ketones, and anion-gap metabolic acidosis, what is the most appropriate initial management step in the ED?

• A. Administer IV bicarbonate therapy to correct acidosis.
• B. Begin insulin infusion immediately without fluids.
• C. Start dextrose-containing fluids immediately to avoid hypoglycemia.
• D. Initiate IV isotonic crystalloid fluid resuscitation and prepare for insulin therapy with potassium monitoring.

Answer: (D)