DKA: NCLEX Priorities
DKA: triad, fluid + insulin + K+ replacement, when add D5.
DKA is diabetic ketoacidosis. NCLEX tests recognition, fluid/insulin/potassium management.
Triad
Hyperglycemia (>250), ketosis, metabolic acidosis (pH <7.3, HCO3 <18). Anion gap elevated.
Recognition
Kussmaul respirations, fruity breath, abdominal pain, N/V, polyuria, polydipsia. Often DM1; can occur in DM2.
Treatment sequence
Fluid first (NS bolus, then 0.45% NS if Na+ allows). Insulin drip (0.1 units/kg/h). Replace K+ even if normal, insulin drives K+ into cells. Add D5 when BG ~250 to prevent hypoglycemia while continuing insulin to close gap.
When transition to SQ insulin
When anion gap closes and patient eating. Overlap IV-SQ by 1-2 hours.
Frequently asked
Why give insulin if K+ low?
Don't, replace K+ first to ≥3.3 before starting insulin. Otherwise risk dangerous hypokalemia.
HHS vs DKA?
HHS: T2DM, BG >600, minimal ketones, pH normal, severe dehydration. Different management, fluid first, less aggressive insulin.
Quick check
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