An adolescent client with Type 1 diabetes mellitus is admitted to the emergency room for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?

A. While anorexia, nausea, and vomiting are common in diabetic ketoacidosis (DKA) due to metabolic acidosis and electrolyte imbalances, hypertension is not typical. In fact, hypotension is more common in DKA because of severe dehydration caused by osmotic diuresis (excessive urination to remove glucose). Thus, hypertension would not be an expected finding. B. Cold, clammy skin and irritability are classic signs of hypoglycemia, not DKA. Hypoglycemia triggers the sympathetic nervous system, causing diaphoresis, pallor, and agitation, which are distinct from the hyperglycemic and dehydrated state seen in DKA. C. Sweating and tremors are also indicative of hypoglycemia. In DKA, the body is in a hyperglycemic, dehydrated state, often presenting with warm, dry skin due to fluid loss, not the cool, clammy skin seen in low blood glucose episodes. D. Fruity or acetone-smelling breath results from ketone accumulation due to fat metabolism in the absence of sufficient insulin. Confusion and altered mental status are consequences of dehydration, hyperglycemia, and electrolyte imbalances, particularly sodium and potassium disturbances. Other hallmark DKA signs include polyuria, polydipsia, abdominal pain, vomiting, tachypnea (Kussmaul respirations), and lethargy. Prompt recognition of these manifestations is critical to initiate fluid replacement, insulin therapy, and electrolyte correction to prevent life-threatening complications.