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Difficulty: HardPhysiological Adaptation

A client is receiving a continuous intravenous regular insulin infusion and 0.9% sodium chloride for the treatment of diabetic ketoacidosis (DKA). Over the past four hours, the client's blood glucose level has decreased from 580 mg/dL to 240 mg/dL. The client suddenly reports profound muscle weakness and a fluttering sensation in the chest. The cardiac monitor displays a new onset of frequent premature ventricular contractions (PVCs). The most recent arterial blood gas analysis reveals a pH of 7.31, PaCO2 of 36 mm Hg, and HCO3 of 16 mEq/L. Which action should the nurse take immediately?

  1. Obtain a stat serum potassium level and prepare to administer an intravenous potassium supplementAnswer
  2. B
    Discontinue the continuous regular insulin infusion to prevent the development of severe hypoglycemia
  3. C
    Administer a prescribed dose of intravenous sodium bicarbonate to correct the metabolic acidosis
  4. D
    Increase the rate of the 0.9% sodium chloride infusion to treat early indicators of hypovolemic shock

Answer

Obtain a stat serum potassium level and prepare to administer an intravenous potassium supplement
Insulin therapy rapidly shifts potassium from the extracellular space into the intracellular space, frequently leading to severe hypokalemia. The client's new-onset muscle weakness and cardiac dysrhythmias (PVCs) are classic signs of hypokalemia, which is a life-threatening complication requiring immediate assessment and replacement.

Step-by-Step Solution

1
Analyze the client's physical symptoms and cardiac rhythm in the context of DKA treatment.
The client is experiencing new-onset muscle weakness and premature ventricular contractions (PVCs) after receiving a continuous insulin infusion.
Identifying new clinical changes during treatment helps pinpoint emerging, treatment-induced complications.
2
Correlate the pathophysiological effects of insulin therapy with the assessment findings.
Insulin actively drives potassium into the cells, lowering serum potassium levels. This rapid shift manifests clinically as muscle weakness and ventricular irritability (PVCs).
Understanding the cellular mechanism of action of insulin ensures accurate interpretation of the presenting symptoms.
3
Evaluate the current ABG values and blood glucose trends.
The blood glucose is 240 mg/dL and the pH is 7.31, indicating the ketoacidosis is resolving but is not yet fully corrected.
This confirms that insulin therapy must continue (with added dextrose) to clear the ketones, ruling out the discontinuation of insulin or the administration of bicarbonate.
4
Determine the highest priority nursing intervention based on life-threatening risks.
Hypokalemia can rapidly progress to fatal cardiac arrhythmias, making immediate potassium assessment and replacement the highest priority.
Electrolyte imbalances directly affecting cardiac rhythm and stability take precedence over routine fluid adjustments.

Key Concept

Hypokalemia as a life-threatening complication of insulin therapy in Diabetic Ketoacidosis (DKA)
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Topics

Physiological Adaptation

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