This is an interesting case. I’m interpreting these as the presenting labs. I think 1-1.5L of lactated ringers (w/o added KCL) is the best choice. LR has some K, K is not that low, the lactate will help shift K into cells by raising pH, and priority is volume.
https://twitter.com/MunerMohamed1/status/1633959436329910272
There’s so much going on here, but remember #nurse the priority intervention for DKA and HHS is to bolus w/ an isotonic solution to maintain adequate circulatory volume. Testable on the #nclex. The hypovolemia is even higher priority than these crazy labs
The right answer on the #nclex for DKA or HHS is to bolus normal saline and that’s what most protocols call for. However, one could postulate Lactated Ringer’s (Hartmann’s) may be superior in DKA b/c the lactate is turned into bicarbonate by the liver txing the acidosis.
In the above I think LR makes more sense than NS b/c 1) it has 4 mEq/L of K and K only 3.1 2) it has less Na than NS + critical high Na 3) lactate txs acidosis + ↑ pH which helps ↑ K. In real life they used NS first then LR + KCL + IV reg insulin w/ success. Isotonic was needed
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