5. Managing a sodium level of 120 in a client with diabetic ketoacidosis is correctly accomplished with:
5. Managing a sodium level of 120 in a client with diabetic ketoacidosis is correctly accomplished with:
. Oral salt tablets.
. Intravenous 3% sodium chloride solution.
. Fluid restriction.
. Insulin and 0.9% sodium chloride.
Test-Taking Tip
Select the option with insulin. Think about the fluid and electrolyte imbalances that occur from a high blood glucose: Blood glucose is elevated (>200 mg/dL) in diabetic ketoacidosis. Knowing why the low sodium (<135) has occurred is important for selecting the correctaction.
Content Area: Adult Health, Endocrine; Integrated Process: Nursing Process, Implementation; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Expected Effects/Outcomes
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Answer 1 is incorrect because clients in diabetic ketoacidosis are dehydrated. They need salt and fluids, which are generally given intravenously. Answer 2 is incorrect because hypertonic saline solutions are not appropriate. Fluids must run fast in these clients who are dehydrated, and this would change sodium levels too quickly. Rapid changes in serum sodium can precipitate a dangerous fluid shift. Answer 3 is incorrect because clients with diabetic ketoacidosis are dehydrated. Fluid restriction is inappropriate. Answer 4 is correct because high blood sugar increases the osmolarity of the blood and stimulates the body to secrete antidiuretic hormone (ADH) to help the kidneys to retain free water, which dilutes the sodium. Obligate diuresis from the osmotic action of sugar in the tubules of the kidneys forces water and sodium loss even though the client is dehydrated. Clients in diabetic ketoacidosis need fluid replacement with normal saline and insulin to return the blood sugar to a normal level.