A client with diabetic ketoacidosis is given regular insulin via infusion pump. Which electrolyte disturbance should the nurse expect to see following the insulin infusion?

Management of diabetic ketoacidosis (DKA) requires intravenous fluid replacement and continuous administration of regular insulin to correct hyperglycemia and metabolic acidosis. Insulin therapy shifts glucose and potassium from the extracellular space into the cells as metabolism is restored. This intracellular shift significantly affects serum electrolyte balance, particularly potassium levels. Careful monitoring of electrolytes is essential during treatment to prevent life-threatening complications. Rationale: A. Hypokalemia is the expected electrolyte disturbance following insulin infusion in diabetic ketoacidosis. Insulin activates the sodium-potassium ATPase pump, driving potassium into the intracellular space along with glucose. This causes a rapid decrease in serum potassium levels, even if initial potassium levels are normal or elevated. Without careful monitoring and replacement, hypokalemia can lead to dangerous cardiac dysrhythmias. B. Hyperkalemia is often present before treatment begins due to insulin deficiency and acidosis causing potassium to shift out of cells. However, once insulin therapy is initiated, potassium shifts back into the cells, reducing serum levels. Therefore, hyperkalemia is not the expected outcome after insulin administration but rather a pre-treatment finding. C. Hypernatremia is not a direct effect of insulin infusion in DKA. Sodium levels in DKA are often low or falsely normal due to osmotic shifts caused by hyperglycemia. Fluid therapy, not insulin, primarily influences sodium balance during treatment. Thus, hypernatremia is not a typical expected electrolyte change from insulin administration. D. Hypocalcemia is not commonly associated with insulin therapy or diabetic ketoacidosis management. Calcium levels are generally unaffected by insulin’s mechanism of action on glucose and potassium transport. Any calcium imbalance would more likely be related to unrelated conditions such as parathyroid dysfunction or renal disease rather than insulin infusion.