Diabetes Mellitus Q 83 - Gyan Darpan : Learning Portal
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Thursday, 7 April 2022

Diabetes Mellitus Q 83

A client was brought to the emergency room with complaints of slurring of speech, vomiting, dry mucosa, and dry skin turgor. Lab tests showing serum sodium 125 mEq/L and serum blood glucose of 350 mg/dL. Nurse Sophie will anticipate the physician to initially order which of the following intravenous solutions?
    A. 10% dextrose in water (D10W)
    B. 0.9% normal saline solution
    C. 5% dextrose in water (D5W)
    D. 0.45% normal saline solution

Correct Answer: B. 0.9% normal saline solution

The client is experiencing diabetic ketoacidosis. Initial priority in the treatment is to restore the extracellular fluid volume through the intravenous administration of 0.9% normal saline at 15-20 ml/kg/h. Immediate fluid resuscitation is vital to correct hypovolemia, restore tissue perfusion, and to clear ketones. Hydration improves glycemic control independent of insulin.

Options A and C: Intravenous solutions containing dextrose will be given once serum glucose reaches 250 mg/dL. When the plasma glucose reaches 200-250 mg/dl, and if the patient still has an anion gap, then dextrose-containing fluids should be initiated, and the insulin infusion rate may need to be reduced.
Option D: 0.45% normal saline will be given once serum sodium stabilizes. In patients who have high serum sodium levels, 0.45% NaCl infused at 4–14 ml/kg/hour or 250–500 mL/hr is appropriate, and for patients with hyponatremia, 0.9% NaCl at a similar rate is preferred.

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