A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which of the following findings would the nurse expect to note as confirming this diagnosis?

Choice A rationale: Diabetic ketoacidosis (DKA) is a severe complication characterized by hyperglycemia, metabolic acidosis, and ketosis. Elevated glucose levels (typically >250 mg/dL) result from insufficient insulin. The body then breaks down fat for energy, producing ketones which lower the blood pH, resulting in metabolic acidosis. The expected finding is a low plasma bicarbonate level (normal range 22-29 mEq/L) reflecting the metabolic acidosis. Choice B rationale: Decreased urine output is an incorrect finding. In DKA, hyperglycemia leads to osmotic diuresis, where excess glucose pulls water out of the body, leading to polyuria (increased urine output) and dehydration. The kidneys attempt to excrete the excess glucose and ketones, resulting in frequent and copious urination. Choice C rationale: Increased respirations (Kussmaul respirations) are a compensatory mechanism for metabolic acidosis, but they lead to a decrease in pH, not an increase. The deep, rapid breathing attempts to blow off carbon dioxide, a form of carbonic acid, to raise the pH back to the normal range of 7.35-7.45. Choice D rationale: While coma can be a late and severe complication of DKA, it is not a confirming diagnostic finding. DKA is confirmed by the specific biochemical triad of hyperglycemia, ketonemia/ketonuria, and metabolic acidosis. Patients are often awake and responsive in the early stages, experiencing symptoms like nausea, abdominal pain, and lethargy.