Stage 2 — Analyze cues. For each finding, select the single role it plays in the current DKA assessment using the 2024 adult hyperglycemic-crisis criteria.
Matrix
Choose your responses, then check the answer.
Explanation
Three required criteria DKA requires diabetes or glucose at least 200 mg/dL, beta-hydroxybutyrate at least 3 mmol/L or urine ketones at least 2+, and pH below 7.3 or bicarbonate below 18 mmol/L. Potassium guides safe treatment and missed insulin identifies a likely precipitant; neither is a fourth diagnostic criterion.
Step 1 — Use the updated D-K-A framework The diabetes or hyperglycemia criterion can be met by a prior diabetes history or glucose at least 200 mg/dL. This avoids missing euglycemic DKA. Quantitative beta-hydroxybutyrate is preferred for the ketone criterion and monitoring. Acidosis is established by venous pH or bicarbonate.
Step 2 — Separate diagnosis from management data Potassium 5.8 does not diagnose DKA, but it determines insulin and replacement safety because serum potassium typically falls during therapy. Missed insulin explains why DKA likely occurred but does not replace any required criterion.
NCLEX rule Ask whether a finding establishes D, K, or A—or instead changes treatment and causal evaluation.
Scenario (Stage 2 — Analyze cues)Quantitative beta-hydroxybutyrate and venous acid-base results are now available.
Clinical judgment targetApply current DKA criteria without using a glucose-above-250 requirement.
Beta-hydroxybutyrate — The predominant circulating ketone in DKA and the preferred quantitative marker for diagnosis and treatment monitoring.
DKA diagnostic triad — Diabetes or hyperglycemia, elevated ketones, and metabolic acidosis; all three components must be present.
Treatment-safety datum — A value such as potassium that may not diagnose DKA but directly changes how therapy is delivered.