A client is admitted with diabetic ketoacidosis (DKA) associated with type 1 diabetes mellitus. The client's blood sugar is 520 mg/dL. The respiratory assessment finding reveals respiratory rate of 32, with a deep, regular respiratory effort. Which insulin will prescribe by the health care provider?

1. A

   NPH insulin SC

2. B

   Regular insulin infusion

3. C

   5% Dextrose IV

4. D

   Sweet juice

Appeared in: NORCET -4 , 2023

Explanation

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• Diabetic Ketoacidosis (DKA) is a medical emergency requiring immediate intervention to lower blood glucose and correct metabolic acidosis.
• Regular insulin is the only insulin preparation that can be administered intravenously, allowing for rapid onset and precise titration of the dose.
• A continuous IV infusion of regular insulin is the standard of care to predictably and safely manage hyperglycemia and ketosis in DKA.
• The goal is a gradual reduction in blood glucose (50-100 mg/dL per hour) to prevent complications like cerebral edema.

Why Other Options Were Wrong

• Option A: NPH insulin is an intermediate-acting insulin administered subcutaneously. Its onset is too slow for the emergency management of DKA, and absorption is unreliable in dehydrated patients.
• Option C: Administering a dextrose solution would worsen the severe hyperglycemia (520 mg/dL) and be extremely harmful.
• Option D: Sweet juice is a rapid-acting carbohydrate used to treat hypoglycemia (low blood sugar). Giving it to a patient with a blood sugar of 520 mg/dL would be dangerous and exacerbate the hyperglycemia.

Related Visual

• Visual 1: Flowchart: Step-by-step management of DKA, showing the sequence of fluid resuscitation, insulin therapy, electrolyte monitoring, and transitioning to subcutaneous insulin.
• Visual 2: Diagram: Illustration of Kussmaul respirations, showing the deep and rapid breathing pattern as a compensatory mechanism for metabolic acidosis.

Clinical Relevance

• Nursing practice connection: Knowing Pharmacological management of Diabetic Ketoacidosis (DKA) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses play a critical role in managing DKA, including hourly monitoring of blood glucose, vital signs, and neurological status.
• A key nursing responsibility is monitoring for and managing complications of treatment, primarily hypokalemia (as insulin drives potassium into cells) and hypoglycemia.
• What if? If the client's blood glucose drops to 240 mg/dL while the insulin infusion is running, the nurse should anticipate an order to change the IV fluid to one containing dextrose (e.g., D5 0.45% NS) to prevent hypoglycemia while continuing to treat the underlying ketosis.

How to Approach the Question

• First, identify the patient's condition from the clinical data. The combination of type 1 diabetes, very high blood sugar (520 mg/dL), and deep, rapid breathing (Kussmaul's) strongly indicates Diabetic Ketoacidosis (DKA).
• Recognize that DKA is a life-threatening medical emergency that requires rapid and controlled intervention.
• The primary goal of immediate treatment is to lower the blood glucose and correct the acidosis. Consider which intervention achieves this most effectively and safely.
• Evaluate the options based on their mechanism and route. An intravenous route is preferred in emergencies for rapid and predictable effects.
• Eliminate options that would worsen the condition (Dextrose, Sweet juice) or are too slow for an emergency (NPH insulin). This leaves the only viable option for emergency IV treatment.

Concept Tested & Keywords

• Concept Tested: Pharmacological management of Diabetic Ketoacidosis (DKA)
• Stem keywords: diabetic ketoacidosis (DKA), type 1 diabetes mellitus, blood sugar 520 mg/dL, deep, regular respiratory effort
• Lead-in keywords: Which insulin
• Clinical cues: Blood sugar of 520 mg/dL indicates severe hyperglycemia.
• Clinical cues: Deep, regular respiratory effort (Kussmaul respirations) is a compensatory mechanism for metabolic acidosis.

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