A nurse is caring for a client in diabetic ketoacidosis (DKA).
Which of the following is the priority intervention by the nurse?
A.
Check potassium levels.
B.
Begin bicarbonate continuous IV infusion.
C.
Initiate a continuous IV insulin infusion.
D.
Administer 0.9% sodium chloride.
The correct answer and Explanation is :
In the management of diabetic ketoacidosis (DKA), the priority intervention is:
D. Administer 0.9% sodium chloride.
Explanation:
Diabetic ketoacidosis (DKA) is a severe complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis. The initial management of DKA focuses on addressing the most critical aspects of the condition to stabilize the patient and prevent further complications.
1. Fluid Resuscitation:
The administration of 0.9% sodium chloride (normal saline) is crucial as the first step in treating DKA. DKA often causes significant dehydration due to polyuria (excessive urination), which leads to electrolyte imbalances and reduced blood volume. Fluid resuscitation with normal saline helps to restore blood volume, improve renal perfusion, and correct electrolyte imbalances. This step is essential to prevent complications such as hypovolemic shock and to prepare the patient for the subsequent management of hyperglycemia and acidosis.
2. Insulin Therapy:
While initiating a continuous IV insulin infusion (option C) is critical for lowering blood glucose levels and halting ketogenesis, it is not the immediate priority. Insulin therapy should be started after adequate fluid resuscitation because insulin alone does not address the dehydration and electrolyte imbalances that need correction first.
3. Potassium Levels:
Checking potassium levels (option A) is also important because DKA treatment can cause shifts in potassium levels, but it comes after fluid resuscitation has begun. Potassium levels need to be monitored closely as insulin treatment and fluid replacement can cause hypokalemia.
4. Bicarbonate Infusion:
Bicarbonate infusion (option B) is generally not recommended in the initial management of DKA unless the patient has severe acidosis with a pH less than 6.9. The main treatment focuses on correcting the underlying hyperglycemia and dehydration rather than directly addressing acidosis with bicarbonate.
In summary, administering 0.9% sodium chloride is the first and immediate priority to stabilize the patient before addressing hyperglycemia and acidosis.