# 請將一位患有糖尿病酮酸中毒且初始鉀離子濃度為 3.0 mmol/L 的成人所需採取的行動依序排列。 > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=zh-tw > language: zh-TW > subject: Medical Emergencies > category: PA ## 題目 請將一位患有糖尿病酮酸中毒且初始鉀離子濃度為 3.0 mmol/L 的成人所需採取的行動依序排列。 每 1 至 2 小時監測血糖，並依計畫間隔監測鉀離子、酮體、pH、體液平衡與治療併發症 評估呼吸道、呼吸、循環、意識狀態、體液容積、血糖、酮體、酸鹼檢驗結果、腎功能與電解質 當鉀離子升至 3.5 mmol/L 以上時，開始醫囑的靜脈注射常規胰島素，並依血糖與酮體反應調整輸液及葡萄糖 開始醫囑的等張或平衡晶體溶液復甦，並評估血流動力學與肺部反應 開始醫囑的鉀離子補充與心臟監測，同時持續進行輸液復甦 ## 解析 先確認 DKA 嚴重度、低血容與電解質風險。開始晶體溶液復甦，接著補充鉀離子，因為初始濃度低於 3.5 mmol/L。延後胰島素直到鉀離子高於 3.5 mmol/L，以降低致命性心律不整與呼吸肌無力的風險。一旦安全後，開始胰島素並持續頻繁監測血糖、鉀離子、酮體、酸鹼狀態與體液平衡。 ## 深入解析 正確順序 評估 → 晶體溶液 → 鉀離子補充 → 僅在鉀離子超過 3.5 mmol/L 後才給予胰島素 → 頻繁多面向監測。 為何正確 DKA 時全身鉀離子總量耗竭。胰島素會將鉀離子移入細胞內，可能使原本已偏低的血清濃度轉變為致命性心律不整或肌肉無力。 NCLEX 決策原則 DKA 且鉀離子低於 3.5 mmol/L 時，輸液與鉀離子補充優先於胰島素。參考資料 12024 高血糖危象共識報告 2Diabetologia 共識發表 ## 臨床情境 DKA 合併低血鉀 個案血糖 468 mg/dL、β-羥基丁酸 5.2 mmol/L、pH 7.19、脫水，且有一條通暢的靜脈管路。醫囑遵循 2024 年國際高血糖危象共識報告。 ## 重要概念 - **β-羥基丁酸** — 用於診斷及追蹤糖尿病酮酸中毒的主要循環酮體。 - **全身鉀離子總量缺乏** — 即使初始血清濃度看似正常或偏高，身體仍流失鉀離子。 - **正常血糖性 DKA** — 即使血糖低於傳統高血糖範圍，仍出現顯著酮症與酸中毒的糖尿病酮酸中毒。 ## 相同主題題目 - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=zh-tw) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=zh-tw) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=zh-tw) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. Laboratory resu…](https://mymerci.kr/pages/nclex_q.php?qn_id=366294&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=395483&lang=vi) --- More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw) _僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_