一位第一型糖尿病病人出現 Kussmaul 呼吸及呼吸中有水果味。護理師預期首要處置為何？
A client with type 1 diabetes mellitus presents with Kussmaul respirations and a fruity breath odor. Which intervention should the nurse anticipate first?
- APerform a blood glucose check進行血糖檢測
- BAdminister 50% dextrose IV push靜脈推注 50% 葡萄糖
- CAdminister subcutaneous regular insulin皮下注射常規胰島素
- DInitiate an intravenous fluid bolus of 0.9% normal saline✓ 正解開始靜脈推注 0.9% 生理食鹽水
這是典型的糖尿病酮酸中毒（DKA）表現。DKA 治療首要任務是恢復循環血量，透過靜脈輸液（生理食鹽水）補足流失的水分，並降低滲透壓。隨後才開始進行胰島素滴注。葡萄糖輸注會加重高血糖，皮下胰島素在酸中毒狀態下吸收不佳，血糖監測雖重要但已具備顯著臨床症狀。
This is a classic presentation of diabetic ketoacidosis (DKA). The first priority in DKA management is to restore circulating volume by intravenous fluid (normal saline) administration to replace fluid losses and reduce osmolality. Insulin infusion is initiated afterward. Dextrose infusion would worsen the hyperglycemia, subcutaneous insulin is poorly absorbed in an acidotic state, and although blood-glucose monitoring is important, significant clinical symptoms are already present.
美台對於 DKA 的治療準則（Protocol）極為相似，皆強調輸液優先、隨後胰島素滴注與電解質補充。