A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?
A. Elevated blood glucose level and a low plasma bicarbonate
B. Decreased urine output
C. Increased respiration and an increase in pH
D. Comatose state
Correct Answer: A. Elevated blood glucose level and a low plasma bicarbonate
In diabetic acidosis, the arterial pH is less than 7.35, plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration.
Option B: Patients may have symptoms of hyperglycemia like polyphagia, polyuria, or polydipsia. As patients become more volume-depleted, they may experience decreased urine output, dry mouth, or decreased sweating indicative of dehydration.
Option C: The client would be experiencing Kussmaul’s respirations. Kussmaul’s breathing, which is labored, deep, and tachypneic, may occur. Some providers may appreciate a fruity scent to the patient’s breath, indicative of the presence of acetone.
Option D: A comatose state may occur if DKA is not treated, but coma would not confirm the diagnosis. In the most severe cases, altered mental status, general drowsiness, and focal neurologic deficits can be appreciated and are signs of cerebral edema. If found, this needs to be treated immediately.
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