一名第一型糖尿病患血糖 450 mg/dL，出現庫斯莫爾呼吸（Kussmaul respirations）與水果味口氣。哪項處置為優先？
A client with type 1 diabetes mellitus presents with a blood glucose of 450 mg/dL, Kussmaul respirations, and a fruity breath odor. Which intervention is the priority?
- APrepare for potassium replacement準備補充鉀離子
- BAdminister a rapid-acting insulin bolus給予快速作用胰島素推注
- CObtain a venous blood gas sample取得靜脈血氣樣本
- DInitiate isotonic saline fluid resuscitation✓ 正解開始等滲鹽水液體復甦
此病患呈現糖尿病酮酸中毒（DKA）。DKA 的首要治療目標為液體復甦，以擴充血管內容積並恢復腎臟灌流，進而幫助排出過高的血糖。胰島素雖然重要，但必須在建立靜脈路徑並確認液體補給後才給予，以防低血壓性休克加劇。
The client is exhibiting classic signs of diabetic ketoacidosis (DKA), including hyperglycemia, Kussmaul respirations, and fruity breath. The priority intervention is initiating isotonic saline fluid resuscitation to restore intravascular volume and renal perfusion, which facilitates the excretion of excess glucose and ketones. While insulin is crucial for treating DKA, fluid replacement must precede it to prevent hemodynamic collapse and ensure safe administration.
美國 Protocol 對於 DKA 輸液速度較為激進；台灣臨床則更謹慎監測心衰竭風險。