— 生理適應 · MEDIUM · MCQ —
一位因糖尿病酮酸中毒（DKA）入院的病人，護理師預期首要給予的靜脈輸液為何？
A client is admitted with diabetic ketoacidosis (DKA). Which IV fluid order should the nurse expect to initiate first?
- A0.45% Sodium Chloride0.45% 氯化鈉
- B5% Dextrose in water5% 葡萄糖水
- C0.9% Sodium Chloride✓ 正解0.9% 氯化鈉
- D5% Dextrose in 0.45% Sodium Chloride5% 葡萄糖加 0.45% 氯化鈉
— Explanation · 中文詳解 —
糖尿病酮酸中毒（DKA）的病理生理基礎是嚴重的胰島素缺乏導致高血糖、酮體堆積與代謝性酸中毒。病人通常因高滲透壓利尿而導致嚴重的細胞外脫水與血容量不足。治療初期，恢復循環血量是首要任務，因此必須首選等張溶液（0.9% Normal Saline）進行快速補充，以維持心臟輸出量與組織灌流。在血容量穩定後，才會根據血糖監測結果加入胰島素與葡萄糖溶液，以避免血糖下降過快導致腦水腫。
Diabetic ketoacidosis causes severe extracellular dehydration and hypovolemia due to osmotic diuresis, making restoration of circulating volume the immediate priority. Therefore, isotonic 0.9% sodium chloride is initiated first for rapid fluid resuscitation to support cardiac output and tissue perfusion before addressing intracellular deficits or hyperglycemia.