護理師照護一位新診斷的第 1 型糖尿病病人，病人出現高血糖。哪種症狀最能指示糖尿病酮酸中毒 (DKA)？（選所有適合的）
A nurse is caring for a client with newly diagnosed type 1 diabetes mellitus. The client is experiencing hyperglycemia. Which symptom is most indicative of diabetic ketoacidosis (DKA)? (Select all that apply.)
- AFruity breath odor✓ 正解果味口臭
- BKussmaul respirations✓ 正解庫斯莫爾氏呼吸
- CPolyuria多尿
- DPolydipsia多渴
- ENausea and vomiting✓ 正解噁心和嘔吐
糖尿病酮酸中毒 (DKA) 是第 1 型糖尿病的嚴重急性併發症。當體內缺乏胰島素，細胞無法利用葡萄糖，身體轉而分解脂肪作為能量，產生酮體 (ketones)，導致代謝性酸中毒。臨床上，為了代償酸中毒，病人會出現庫斯莫爾呼吸 (Kussmaul respirations) 以排出二氧化碳；酮體經由呼吸道排出，形成特殊的水果味口氣。噁心嘔吐則是電解質失衡與酸中毒常見的全身性症狀。護理師需優先監測意識狀態、血糖及電解質，並準備補液與胰島素治療。
Diabetic ketoacidosis (DKA) is a severe acute complication of type 1 diabetes mellitus. When the body lacks insulin and cells cannot use glucose, the body turns to fat breakdown for energy, producing ketones and resulting in metabolic acidosis. Clinically, to compensate for the acidosis, the client develops Kussmaul respirations to blow off carbon dioxide; ketones are also exhaled through the respiratory tract, producing a characteristic fruity breath odor. Nausea and vomiting are common systemic symptoms of electrolyte imbalance and acidosis. The nurse must prioritize monitoring level of consciousness, blood glucose, and electrolytes, and prepare for fluid resuscitation and insulin therapy.
台美臨床對於 DKA 的處理原則一致，均強調「補液優先 (Fluid resuscitation)」，隨後才進行胰島素輸注以糾正酸中毒。美國醫療機構更強調在開始胰島素治療前必須確保血鉀水平高於 3.3 mEq/L，否則會導致致命性心律不整。