A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:
A. Administer regular insulin intravenously
B. Administer 5% dextrose intravenously
C. Correct the acidosis
D. Apply an electrocardiogram monitor
Correct Answer: A. Administer regular insulin intravenously
Lack (absolute or relative) of insulin is the primary cause of DK1. Intravenous insulin by continuous infusion is the standard of care. A more recent prospective randomized trial demonstrated that a bolus is not necessary if patients are given hourly insulin infusion at 0.14 U/kg/hr.
Option B: Isotonic fluids have been well established for more than 50 years as preferred fluids. Colloids vs. crystalloids were compared for critically ill patients, in a 2013 meta-analysis, and crystalloid was found to be non-inferior.
Option C: Treatment consists of insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium replacement, followed by correcting acidosis. Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. Hydration improves glycemic control independent of insulin.
Option D: Applying an electrocardiogram monitor is not a priority action. Hourly point-of-care testing (POCT) glucose should be performed. Initial VBG or ABG monitoring, followed by as-needed precipitating events.
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