An adult client arrives at the emergency department presenting with profound lethargy, deep and rapid Kussmaul respirations, and a fruity breath odor. Laboratory results reveal a blood glucose of 680 mg/dL (37.7 mmol/L), a serum pH of 7.15, and positive serum ketones. Arrange the following collaborative interventions in the correct sequence of priority.
- 1Establish large-bore intravenous access and initiate a rapid infusion of 0.9% sodium chloride.
- 2Obtain a serum potassium level and a basic metabolic panel.
- 3Administer a continuous intravenous infusion of regular insulin.
- 4Add 5% dextrose to the maintenance intravenous fluids.
- 5Administer the first scheduled dose of subcutaneous insulin.
Cevap
The correct sequence prioritizes hemodynamic stability and safety: administer intravenous fluids first, check the potassium level second, start the continuous regular insulin infusion third, add dextrose to the fluids when glucose falls below 250 mg/dL fourth, and transition to subcutaneous insulin fifth.
The established protocol for severe metabolic decompensation prioritizes ABCs and hemodynamics. Dehydration from osmotic diuresis requires immediate 0.9% sodium chloride to restore vascular volume. Next, potassium must be evaluated because insulin drives potassium into cells, risking life-threatening hypokalemia. Only after volume and electrolytes are secured is regular insulin infused to correct the acidosis. Dextrose is later added when glucose drops below 250 mg/dL to prevent hypoglycemia while waiting for ketones to clear. Finally, a subcutaneous insulin dose provides overlapping coverage before the intravenous drip is stopped.
Adım Adım Çözüm
Anahtar Kavram
The acute management of diabetic ketoacidosis (DKA) strictly prioritizes fluid resuscitation followed by electrolyte evaluation before the administration of insulin.
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