A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH).
The nurse would monitor the client for which of the following electrolyte imbalances?

Choice A reason: This hypotonic saline solution is often used after initial resuscitation, especially when the patient’s serum sodium is normal or elevated. It helps replace intracellular fluid losses and provides ongoing hydration without excessively increasing sodium levels. It is typically administered once the initial intravascular volume is restored with isotonic fluids.

Choice B reason: This isotonic saline solution is the first-line intravenous fluid used in DKA. It helps expand intravascular volume quickly, restore tissue perfusion, and correct hypovolemia caused by osmotic diuresis. It is given initially as a bolus, followed by continuous infusion until the patient is stabilized.

Choice C reason: This dextrose-containing solution is introduced once blood glucose falls to approximately 200–250 mg/dL. At this point, insulin therapy must continue to clear ketones and correct acidosis, but dextrose is added to prevent hypoglycemia. It is usually combined with saline (e.g., D5 0.45% NS) to balance hydration and glucose support.

Choice D reason: This balanced electrolyte solution is not typically the preferred fluid in DKA management because the lactate component may complicate interpretation of acid–base status. Although it can expand volume, it is generally avoided in favor of saline solutions that more directly address dehydration and electrolyte imbalance in DKA.

Choice E reason: This form of insulin is the only type used intravenously in DKA. A continuous infusion of regular insulin is essential to reduce blood glucose, suppress ketone production, and correct metabolic acidosis. It is carefully titrated with close monitoring of electrolytes, especially potassium, since insulin drives potassium into cells and can cause hypokalemia.

This is because intravenous potassium supplementation is indicated for patients with profound hypokalemia (plasma K+ <2.5 mmol/L) or cardiac arrhythmia. The rate of infusion should not exceed 10 mmol/hour to prevent complications such as hyperkalemia, cardiac arrhythmias, and phlebitis.

Choice A is wrong because monitoring urine output every 8 hours is not sufficient to prevent complications from intravenous potassium replacement therapy.

Urine output should be monitored more frequently (at least every 4 hours) to assess renal function and fluid balance.

Choice B is wrong because administering potassium via a bolus injection is dangerous and can cause fatal cardiac arrhythmias.

Potassium should never be given by intravenous push or intramuscular injection.

Choice D is wrong because encouraging the client to eat potassium-rich foods is not appropriate for patients receiving intravenous potassium replacement therapy.

Oral potassium supplementation is preferred for patients with mild to moderate hypokalemia (plasma K+ 2.5-3.5 mmol/L) who can eat and absorb oral potassium.

Potassium-rich foods include potatoes, legumes, juices, seafood, leafy greens, dairy, tomatoes and bananas.