What clinical manifestation associated with a Wilms tumor is the reason most children are initially brought in to be seen by a provider?

Choice A reason: IV fluid replacement in DKA is typically isotonic, not hypertonic, to avoid rapid changes in osmolality.
Choice B reason: While monitoring for cardiac arrest is important, it is not the primary intervention; DKA often presents with low potassium levels that rise with treatment.
Choice C reason: Monitoring for hypertension is important, but the primary concern in DKA is managing the acidosis and hyperglycemia.
Choice D reason: This is the correct choice. Administering insulin is a key component of treating DKA to reduce blood glucose levels and reverse ketosis. NPH insulin is not typically used in the initial management of DKA; rapid-acting insulin is preferred. However, if NPH is mentioned in the context provided, it would be important to clarify the treatment protocol.

Choice A reason: Assessing pedal pulses is important, but it does not provide complete information about the circulatory status of the infant.
Choice B reason: This is the correct choice. Discrepancies in pulse strength between the upper and lower extremities may indicate a cardiovascular problem such as coarctation of the aorta, which can be further evaluated by comparing blood pressures in all four extremities.
Choice C reason: Lower extremity reflexes are not directly related to the strength of pulses.
Choice D reason: Hemoglobin and hematocrit values are important but would not be the next step in assessing the significance of the difference in pulse strength.