👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: DKA · diabetic acidosis · ketoacidosis
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Use this quick-reference guide to spot, treat, and prevent Diabetic Ketoacidosis (DKA) on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
🩺 Signs
Kussmaul breaths, fruity breath
Polyuria, polydipsia, dehydrated
↑ ketones, ↓ HCO3, ↓ pH
✅ Do
IV fluids NS first priority
Regular insulin IV drip
Add dextrose when glucose ~250
🩺 Watch
K+ drops as insulin given
Replace K+, monitor ECG
🚩 Report
Cerebral edema if too-fast drop
Hourly glucose, neuro checks
📚 Diabetic Ketoacidosis (DKA) — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
DKA is a life-threatening complication of (usually type 1) diabetes from severe insulin deficiency: the body burns fat for fuel, producing ketones and metabolic acidosis. It is marked by hyperglycemia, ketosis, dehydration, and acidosis, often triggered by illness or missed insulin.
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Key points
Understand these first
Blood glucose usually > 250 mg/dL with ketones in blood/urine
Kussmaul respirations (deep, rapid) and fruity (acetone) breath
Polyuria, polydipsia, dehydration, and altered mental status
IV fluids first — 0.9% normal saline to correct dehydration
Regular insulin IV infusion to lower glucose gradually
Replace potassium — insulin drives K⁺ into cells and can cause hypokalemia
Add dextrose to fluids when glucose nears 200–250 to avoid hypoglycemia
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Red flags — report now
Escalate immediately
Falling potassium during insulin therapy — monitor and replace before it drops
Declining LOC or pH < 7.0 — escalate immediately
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Labs & values
Numbers to know
Glucose > 250 mg/dL
Arterial pH < 7.35
Positive serum/urine ketones
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Patient teaching
What patients must know
Never skip insulin, even when sick; check glucose and ketones during illness
❓ Diabetic Ketoacidosis (DKA): NCLEX FAQs
What are the priority nursing interventions for Diabetic Ketoacidosis (DKA)?
IV fluids first — 0.9% normal saline to correct dehydration. Regular insulin IV infusion to lower glucose gradually. Replace potassium — insulin drives K⁺ into cells and can cause hypokalemia. Add dextrose to fluids when glucose nears 200–250 to avoid hypoglycemia.
What are the warning signs of Diabetic Ketoacidosis (DKA) a nurse must report?
Falling potassium during insulin therapy — monitor and replace before it drops. Declining LOC or pH < 7.0 — escalate immediately.
What do I need to know about Diabetic Ketoacidosis (DKA) for the NCLEX?
Blood glucose usually > 250 mg/dL with ketones in blood/urine. Kussmaul respirations (deep, rapid) and fruity (acetone) breath. Polyuria, polydipsia, dehydration, and altered mental status. Metabolic acidosis: arterial pH < 7.35, low bicarbonate.
What patient teaching is important for Diabetic Ketoacidosis (DKA)?
Never skip insulin, even when sick; check glucose and ketones during illness.
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Quick Tip
Blood glucose usually > 250 mg/dL with ketones in blood/urine.