Promoting Fluid and Electrolyte Balance
Promoting Fluid and Electrolyte Balance ( 5 Questions)
A nurse is reviewing the laboratory results of a client who has diabetic ketoacidosis (DKA) and is receiving 0.45% sodium chloride (1/2 normal saline) intravenously. Which of the following findings indicates that the therapy is effective?
Decreased serum osmolarity. This is the correct answer because the goal of therapy for diabetic ketoacidosis (DKA) is to restore fluid and electrolyte balance, correct acidosis, and lower blood glucose levels. 0.45% sodium chloride (1/2 normal saline) is a hypotonic solution that helps to rehydrate the intracellular and extracellular compartments and reduce the serum osmolarity, which is elevated in DKA due to hyperglycemia and dehydration.
Increased urine specific gravity. This is incorrect because urine specific gravity reflects the concentration of solutes in the urine. In DKA, urine specific gravity is usually high due to osmotic diuresis caused by hyperglycemia and ketonuria. Effective therapy for DKA should lower the urine specific gravity as the blood glucose level and hydration status improve.
Decreased serum bicarbonate level. This is incorrect because serum bicarbonate level reflects the metabolic component of acid-base balance. In DKA, serum bicarbonate level is low due to increased production of ketoacids that consume bicarbonate as a buffer. Effective therapy for DKA should increase the serum bicarbonate level as the acidosis is corrected by insulin and fluid administration.
Increased serum potassium level. This is incorrect because serum potassium level is affected by several factors in DKA, such as insulin deficiency, acidosis, osmotic diuresis, and fluid therapy. In DKA, serum potassium level may be normal or high initially due to the shift of potassium from the intracellular to the extracellular space, but the total body potassium is depleted. Effective therapy for DKA should normalize the serum potassium level by replacing potassium losses and correcting the factors that cause potassium shift.
Choice A reason:
Decreased serum osmolarity. This is the correct answer because the goal of therapy for diabetic ketoacidosis (DKA) is to restore fluid and electrolyte balance, correct acidosis, and lower blood glucose levels. 0.45% sodium chloride (1/2 normal saline) is a hypotonic solution that helps to rehydrate the intracellular and extracellular compartments and reduce the serum osmolarity, which is elevated in DKA due to hyperglycemia and dehydration.
Choice B reason:
Increased urine specific gravity. This is incorrect because urine specific gravity reflects the concentration of solutes in the urine. In DKA, urine specific gravity is usually high due to osmotic diuresis caused by hyperglycemia and ketonuria. Effective therapy for DKA should lower the urine specific gravity as the blood glucose level and hydration status improve.
Choice C reason:
Decreased serum bicarbonate level. This is incorrect because serum bicarbonate level reflects the metabolic component of acid-base balance. In DKA, serum bicarbonate level is low due to increased production of ketoacids that consume bicarbonate as a buffer. Effective therapy for DKA should increase the serum bicarbonate level as the acidosis is corrected by insulin and fluid administration.
Choice D reason:
Increased serum potassium level. This is incorrect because serum potassium level is affected by several factors in DKA, such as insulin deficiency, acidosis, osmotic diuresis, and fluid therapy. In DKA, serum potassium level may be normal or high initially due to the shift of potassium from the intracellular to the extracellular space, but the total body potassium is depleted. Effective therapy for DKA should normalize the serum potassium level by replacing potassium losses and correcting the factors that cause potassium shift.