A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first?
A.
Bring the patient a meal.
B.
Administer Lantus insulin IV.
C.
Give sodium bicarbonate 50 mEq IV push.
D.
Start an infusion of normal saline at 125 ml/hr.
The correct answer and Explanation is :
The correct answer is D. Start an infusion of normal saline at 125 ml/hr.
Explanation:
In the case of diabetic ketoacidosis (DKA), the immediate priority is to address the fluid and electrolyte imbalances and to restore hemodynamic stability. DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis, often with significant dehydration. The initial management focuses on:
- Fluid Resuscitation: Starting an infusion of normal saline is crucial because DKA commonly results in significant fluid loss. The patient typically presents with dehydration due to osmotic diuresis caused by hyperglycemia. Normal saline (0.9% sodium chloride) helps restore the intravascular volume and improves renal perfusion, which is essential for effective glucose and ketone clearance. The recommended starting rate for normal saline is often 1-2 liters over the first few hours, adjusted based on the patient’s hemodynamic status and response.
- Insulin Administration: While insulin is critical in managing DKA by lowering blood glucose levels and halting ketogenesis, it is not the first action. Intravenous insulin is typically administered after the patient has received initial fluid resuscitation and electrolyte imbalances are being addressed.
- Electrolyte Management: Sodium bicarbonate may be used in severe cases of acidosis but is not a first-line treatment in most cases of DKA unless the pH is extremely low (below 6.9) and the patient shows signs of severe acidosis. The primary focus remains on fluid resuscitation and insulin therapy.
- Nutrition: Providing a meal is not appropriate until the patient’s blood glucose levels and ketone levels have been stabilized, and they are able to eat safely.
Thus, the first action to implement in DKA management is to start an infusion of normal saline to rehydrate the patient and address the fluid deficit, which sets the stage for subsequent treatments like insulin therapy and electrolyte management.