護理師正在評估一位糖尿病酮酸中毒（DKA）病人的治療反應。下列哪項發現顯示治療有效？
The nurse is evaluating a client's response to treatment for diabetic ketoacidosis (DKA). Which finding indicates that the treatment is effective?
- ASerum bicarbonate level of 18 mEq/L血清碳酸氫根濃度為 18 mEq/L
- BBlood glucose level of 250 mg/dL血糖濃度為 250 mg/dL
- CAnion gap of 10 mEq/L✓ 正解陰離子間隙為 10 mEq/L
- DUrine output of 20 mL/hr尿量為 20 mL/hr
DKA 治療的終極目標不是讓血糖恢復正常，而是「關閉陰離子間隙（Anion Gap）」並糾正酸中毒。陰離子間隙正常值約為 8-12 mEq/L。在 DKA 中，因為酮體（酸性物質）堆積，陰離子間隙會顯著升高。當陰離子間隙恢復正常時，代表酮體已被代謝掉，代謝性酸中毒得到緩解。血糖下降（B）雖然是進展，但有時血糖降了但酸中毒尚未糾正；血碳酸氫根 18（A）仍低於正常；尿量 20mL/hr（D）過低，顯示脫水未完全糾正。因此，陰離子間隙是判斷 DKA 緩解最可靠的指標。
The most reliable indicator that diabetic ketoacidosis treatment is effective is a normal anion gap, which signifies that ketosis and metabolic acidosis have resolved. While blood glucose decreases during treatment, it does not confirm the resolution of acidosis, and serum bicarbonate levels may remain low initially. Additionally, urine output should be at least 30 mL/hr to indicate adequate hydration, making 20 mL/hr insufficient.
美國 DKA 治療協議（Protocols）非常強調陰離子間隙的追蹤，並據此決定何時停用胰島素點滴；台灣臨床則常以血糖值與尿酮（Urine Ketone）轉陰作為主要參考點，兩者在邏輯重點上略有不同。