一名 45 歲糖尿病酮酸中毒（DKA）患者入院。在開始輸液復甦後，護理師在進行胰島素治療時，應優先監測哪種電解質失衡？

DKA 患者體內鉀離子總量雖常因多尿而耗竭，但在酸中毒狀態下，氫離子進入細胞內以交換鉀離子，導致血鉀濃度常維持正常或偏高。一旦開始胰島素治療，胰島素會促進葡萄糖與鉀離子進入細胞，引發快速的血鉀下降，這對心臟傳導極其危險。因此，必須在血鉀數值穩定（通常需大於 3.3 mEq/L）後才能給予胰島素，治療過程中需持續監測心電圖與鉀離子變化。其他選項如高血鈉或低血鈣雖可能存在，但低血鉀引發的心律不整威脅性最高，屬於治療過程中的核心監測指標。

Although the total body potassium of a patient with DKA is often depleted because of polyuria, in the acidotic state hydrogen ions move into the cells in exchange for potassium, so the serum potassium often remains normal or elevated. Once insulin therapy is initiated, insulin drives glucose and potassium into the cells, producing a rapid fall in serum potassium that is extremely dangerous for cardiac conduction. Insulin must therefore not be administered until the serum potassium is stable (generally above 3.3 mEq/L), and ECG and potassium levels must be monitored continuously during treatment. Other options, such as hypernatremia or hypocalcemia, may also be present, but the dysrhythmias caused by hypokalemia pose the greatest threat and are the core monitoring parameter during treatment.

美國護理指引對 DKA 的血鉀監測頻率有嚴格的 protocol，包含每小時檢測直到穩定；台灣臨床則多依賴主治醫師醫囑調整頻率，且護理師在點滴設定上通常需頻繁與醫師確認鉀離子補充速度。