A client is admitted with suspected diabetic ketoacidosis (DKA). Which findings should the nurse expect? (Select all that apply.)

Diabetic ketoacidosis is an acute metabolic emergency driven by absolute insulin deficiency and concomitant surges in counter-regulatory hormones. This hormonal imbalance accelerates uninhibited lipolysis, shifting hepatic metabolism toward the synthesis of acidic ketone bodies. The resulting severe metabolic acidosis triggers respiratory compensation mechanisms and profound systemic osmotic diuresis. A. Polyuria: Severe hyperglycemia exceeding 13.9 mmol/L overwhelms the maximum renal tubular transport capacity for glucose, inducing solute-driven osmotic diuresis. The kidneys excrete massive fluid volumes, depleting intravascular reserves and causing intracellular dehydration. This represents an initial compensatory elimination mechanism. B. Fruity breath odor: The volatilization and pulmonary excretion of accumulated acetoacetate and acetone molecules produce a distinctive sweet, volatile olfactory marker. This characteristic breath odor arises directly from the systemic accumulation of ketonic acids. It provides an immediate bedside sign of ketonemia. C. Bradycardia: Intravascular volume depletion and metabolic acidemia strongly stimulate peripheral baroreceptors, driving compensatory sinus tachycardia to maintain tissue perfusion. A slow heart rate is highly atypical unless profound hyperkalemia induces conduction blocks. Tachycardia is the expected cardiovascular response. D. Kussmaul respirations: The respiratory center triggers deep, rapid, sighing hyperventilation to eliminate carbon dioxide and mitigate metabolic acidemia. This classic breathing pattern represents an auto-regulatory attempt to restore normal physiological arterial pH levels. It signals an advanced stage of metabolic compensation. E. Abdominal pain: Systemic metabolic acidosis, delayed gastric emptying, and localized ileus induced by electrolyte shifts provoke acute, severe visceral abdominal distress. This presentation frequently mimics an acute surgical abdomen in pediatric and young adult populations. The pain resolves with insulin and fluid resuscitation.