一位 18 歲第一型糖尿病男性被送進急診時嗜睡，呈現庫斯莫呼吸與酮體水果味呼吸。血糖 550 mg/dL、pH 7.15（嚴重代謝性酸中毒），確診糖尿病酮酸中毒（DKA）。護理師首要兩項介入為何？
An 18-year-old male with Type 1 diabetes is brought to the ED somnolent with Kussmaul respirations and fruity-acetone breath. Glucose is 550 mg/dL and blood pH 7.15 (severe metabolic acidosis), confirming DKA. Which two interventions are the nurse's first priority?
- AIntubate immediately and withhold insulin until ketones clear naturally.立即插管，並延遲給藥胰島素直到酮體自然清除。
- BPush IV sodium bicarbonate boluses, followed by long-acting subcutaneous NPH insulin.推注靜脈注射碳酸氫鈉衝劑，隨後給予長效皮下注射 NPH 胰島素。
- CInfuse 0.9% normal saline to correct dehydration, followed by a controlled IV insulin drip.✓ 正解輸注 0.9% 生理食鹽水以糾正脫水，隨後給予控制的靜脈注射胰島素滴注。
- DAdminister IV glucagon and restrict fluid intake to prevent pulmonary edema.給予靜脈注射胰高血糖素，並限制液體攝取以防止肺水腫。
DKA 治療三大支柱：補液（fluids）→ 胰島素（insulin）→ 鉀（potassium）。 選項 C 正確：先以 0.9% 生理食鹽水大量補液矯正嚴重脫水（DKA 病人多脫水 6-9 公升），然後啟動 IV regular insulin drip 慢慢降血糖、停止脂肪分解。注意：胰島素啟動前需確認血鉀 ≥ 3.3 mEq/L 否則會引發致命低血鉀。 選項 D 錯誤：Glucagon 升血糖反作用；不可限水。 選項 B 錯誤：NaHCO3 僅在 pH < 6.9 才考慮；NPH 為長效不適急救。 選項 A 錯誤：插管非必要；停胰島素會惡化 DKA。
DKA treatment pillars: fluids → insulin → potassium. B correct: First, 0.9% normal saline corrects severe dehydration (DKA patients are typically 6-9 L fluid-deficient). Then start a regular IV insulin drip to lower glucose and halt lipolysis. Verify K+ ≥ 3.3 mEq/L before insulin to avoid fatal hypokalemia. A incorrect: Glucagon raises glucose—wrong direction; fluid restriction is dangerous. C incorrect: Bicarbonate only considered when pH < 6.9; NPH is long-acting and inappropriate in acute crisis. D incorrect: Intubation usually unnecessary; withholding insulin worsens DKA.
「DKA 先救水 (給重力 Normal Saline)，再滴 Regular Insulin (只有它能走靜脈滴注 IV drip)」。這在 AC LS 的內分泌緊急處置中如同九九乘法表，所有的考題一定會考這個順序與特異性藥種的配對。