Which physician’s order should the nurse question for a newly admitted client diagnosed with diabetic ketoacidosis (DKA)?
1 D5W at 125 mL per hour
2 KCL 10 mEq in 100 mL NaCl IV now
3 Stat arterial blood gases. Administer sodium bicarbonate if pH is less than 7.0.
4 Regular insulin infusion per protocol adjusting dose based on hourly glucose levels
The correct answer and explanation is :
The correct answer is Option 1: D5W at 125 mL per hour.
Explanation:
Diabetic ketoacidosis (DKA) is a life-threatening emergency most commonly seen in individuals with type 1 diabetes, characterized by hyperglycemia, ketonemia, and acidosis. Effective treatment involves correcting hyperglycemia, dehydration, electrolyte imbalances, and acidosis, and closely monitoring the client’s condition.
1. D5W at 125 mL per hour:
This order should be questioned. D5W (5% dextrose in water) is a hypotonic solution and contains glucose. Administering glucose (especially in the form of D5W) is contraindicated in DKA during the initial treatment phase because it could exacerbate hyperglycemia. The initial phase of DKA treatment typically focuses on rehydration with isotonic fluids such as Normal Saline (0.9% sodium chloride) to restore circulatory volume and improve kidney function. Adding glucose too soon may interfere with the goal of lowering blood glucose levels and correcting ketoacidosis. Once the blood glucose level has decreased to around 200 mg/dL, then a solution like D5W may be considered, but not during the initial treatment phase.
2. KCL 10 mEq in 100 mL NaCl IV now:
This order is appropriate. Potassium chloride (KCl) is commonly administered to patients with DKA, as insulin therapy (which is used to reduce blood glucose levels) can lower potassium levels in the blood. Since potassium may be depleted, it is essential to monitor and replace potassium as needed to avoid hypokalemia. However, potassium replacement should not occur until urine output is adequate, as the kidneys must be functional for potassium excretion.
3. Stat arterial blood gases (ABGs). Administer sodium bicarbonate if pH is less than 7.0:
This order is appropriate. ABGs are crucial for assessing the severity of acidosis in DKA. Sodium bicarbonate is only used when the pH is very low (typically below 7.0) and the acidosis is severe. However, sodium bicarbonate is generally avoided unless the acidosis is life-threatening, as it may have complications like cerebral edema.
4. Regular insulin infusion per protocol adjusting dose based on hourly glucose levels:
This order is appropriate. A continuous regular insulin infusion is the mainstay of treatment for DKA. The insulin infusion is typically titrated based on hourly blood glucose levels to ensure a gradual reduction of blood glucose, which helps to prevent complications like cerebral edema.
Thus, the order that should be questioned is D5W at 125 mL per hour, as it could worsen the hyperglycemia during the initial stages of DKA treatment.