# Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. Classify each finding by the clinical decision it supports. More than one column may apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=522750&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PPT ## Question Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. Classify each finding by the clinical decision it supports. More than one column may apply. | | Supports euglycemic DKA | Supports urinary infection precipitant | Supports volume depletion | | --- | --- | --- | --- | | Beta-hydroxybutyrate 5.2 mmol/L with pH 7.24 | | | | | Temperature 38.7 C with dysuria and pyuria | | | | | Repeated vomiting with dry mucous membranes | | | | | Urine culture is pending after the specimen was collected | | | | | Glucose 184 mg/dL while taking empagliflozin | | | | | Normal ankle skin and a current eye examination | | | | ## Explanation Ketonemia and acidosis support euglycemic DKA, while fever, dysuria, pyuria, and culture findings support infection as the precipitant. Vomiting and poor intake worsen dehydration and can support both pathways. ## In-depth explanation Quick answer Separate the metabolic emergency from its infectious precipitant. Why this is correct Treating only the glucose or only the infection leaves part of the causal chain active. The nurse connects ketones and acid-base findings to DKA while obtaining ordered infection evidence and supporting timely treatment. Easy analogy or mental picture Build a medication safety chain: identify the cue cluster, connect it to the drug mechanism, stop preventable exposure, stabilize the client, and verify the response with measurable findings. Memory hook Cue cluster, medication mechanism, protective action, and measurable reassessment. NCLEX decision rule Choose the action that prevents the most immediate medication-related harm while preserving treatment for the underlying condition. Why the other choices are wrong Options that rely on one reassuring value, continue a suspect exposure, bypass monitoring, or delay escalation leave the medication hazard active.References 1FDA Drug Safety Communication: SGLT2 inhibitor ketoacidosisKetoacidosis can occur with lower-than-expected glucose during infection, reduced intake, surgery, dehydration, or insulin reduction 22024 Consensus Report: Hyperglycemic Crises in Adults With DiabetesEuglycemic DKA recognition, fluids, insulin, dextrose, potassium, precipitant treatment, and resolution criteria 3Surviving Sepsis Campaign International Guidelines 2021Prompt infection evaluation, cultures when appropriate, antimicrobials, fluids, perfusion, and serial reassessment ## Clinical scenario Clinical context An adult taking empagliflozin develops fever, poor intake, vomiting, and deep rapid respirations during a urinary infection; glucose is 184 mg/dL, beta-hydroxybutyrate 5.2 mmol/L, bicarbonate 12 mEq/L, and venous pH 7.24, establishing euglycemic diabetic ketoacidosis. ## Related questions - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. 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