A nurse is caring for a client in the emergency department. The nurse is caring for the client in the ED. The nurse understands that the client is at risk of developing which of the following complications? Select all that apply.

Rationale: A. Renal failure: The client’s elevated BUN (21 mg/dL) and creatinine (1.7 mg/dL), along with signs of dehydration such as decreased skin turgor and hypotension, indicate impaired renal perfusion. In hyperglycemic crises like DKA or HHS, severe dehydration and reduced renal blood flow increase the risk for acute kidney injury if fluid resuscitation is delayed. B. Cardiac arrhythmias: Hyperkalemia (potassium 5.5 mEq/L) combined with acidosis (pH 7.30) increases myocardial excitability and the risk for cardiac arrhythmias. Electrolyte imbalances are common in hyperglycemic emergencies due to shifts between intracellular and extracellular compartments, especially when insulin therapy and fluid replacement are initiated. C. Hypotension: The client’s blood pressure is 96/65 mm Hg, suggesting volume depletion secondary to osmotic diuresis from severe hyperglycemia. Dehydration reduces intravascular volume, which can worsen hypotension and compromise perfusion to vital organs. Continuous monitoring and fluid resuscitation are essential to prevent shock. D. Septic shock: While the client recently had bronchitis and pneumonia, there is no current fever, leukocytosis, or hemodynamic instability indicating sepsis. Septic shock is not an immediate complication in this scenario, though infection may have precipitated the hyperglycemic episode. E. Cerebral edema: This is a rare but severe complication of DKA treatment. If blood glucose levels are lowered too rapidly or if the osmolarity of the blood changes too quickly during fluid resuscitation, fluid can shift into the brain cells, causing swelling. F. Respiratory alkalosis: The client’s pH is 7.30, indicating acidosis rather than alkalosis. Hyperglycemic crises typically cause metabolic acidosis (especially in DKA) due to ketone accumulation, not respiratory alkalosis.