# 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.

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> subject: Expected Actions/Outcomes  
> category: PPT

## Question

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.

|  | Diabetes or hyperglycemia criterion | Ketonemia criterion | Metabolic acidosis criterion | Treatment-safety or precipitant information |
| --- | --- | --- | --- | --- |
| Type 1 diabetes with glucose 478 mg/dL |  |  |  |  |
| Beta-hydroxybutyrate 6.8 mmol/L |  |  |  |  |
| Venous pH 7.18 and bicarbonate 9 mmol/L |  |  |  |  |
| Serum potassium 5.8 mmol/L before insulin |  |  |  |  |
| No insulin taken for 36 hours |  |  |  |  |

## 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.

## In-depth explanation

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.

## Clinical scenario

Scenario (Stage 2 — Analyze cues)
Quantitative beta-hydroxybutyrate and venous acid-base results are now available.

Clinical judgment target
Apply current DKA criteria without using a glucose-above-250 requirement.

## Key concepts

- **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.

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