A client with a history of diabetes presents to the emergency department following several days of polyuria and polydipsia with nausea/vomiting

Question

On admission, the client labs show a blood glucose level of 480 mg/dL and bicarbonate level of 7.8 mEq/dL. The nurse suspects the client has diabetic ketoacidosis (DKA). The priority intervention should include:
A) Limit fluid intake to only 250 mL/4 hours.
B) Begin a loading dose of IV regular insulin followed by a continuous insulin infusion.
C) Give at least 50 units of regular insulin IV stat and recheck blood glucose in 2 hours.
D) Push a stat dose of bicarbonate followed by a double-dose (loading) of metformin.

Answer 1

Ans: B
Feedback:
The goals in treating DKA are to improve circulatory volume and tissue perfusion, decrease blood glucose, and correct the acidosis and electrolyte imbalances. These objectives usually are accomplished through the administration of insulin and intravenous fluid and electrolyte replacement solutions. An initial loading dose of short-acting (i.e., regular) or rapid-acting insulin often is given intravenously, followed by continuous low-dose short-acting insulin infusion. Frequent laboratory tests are used to monitor blood glucose. The fluids need to be replaced, not withheld. Too rapid a drop in blood glucose may cause hypoglycemia that can occur with a large dose of regular insulin. The client may require bicarbonate, but glucose levels are lowered with insulin in this emergency situation, not by oral medication.