A nurse is caring for a client who is 12 hr postoperative and has a chest tube to a disposable water-seal drainage system with suction. The nurse should intervene for which of the following observations?

A. Glucocorticoid medications are not used to treat DKA. In fact, glucocorticoids can increase blood glucose levels and exacerbate hyperglycemia.
B. Dextrose 5% in 0.45% sodium chloride is not appropriate for the initial treatment of DKA. Initially, IV fluids containing normal saline (0.9% sodium chloride) are used to correct dehydration and restore electrolyte balance.
C. Oral hypoglycemic medications are not effective in DKA, as it is a serious acute complication of diabetes that requires insulin therapy and IV fluids, not oral medications.
D. 0.9% sodium chloride IV bolus is the first-line treatment for DKA to rehydrate the patient, correct electrolyte imbalances, and dilute the high blood glucose level. After stabilization, insulin therapy is also introduced.

A. Cerebral edema is the most dangerous complication associated with the administration of hypotonic fluids in patients with diabetic ketoacidosis (DKA). This occurs because hypotonic fluids cause rapid shifts in fluid and electrolytes, which can lead to swelling of the brain, especially in children. The risk is heightened if fluids are replaced too quickly.
B. Polyuria is a common symptom of diabetic ketoacidosis due to high blood glucose levels and osmotic diuresis, but it is not caused by hypotonic fluid administration.
C. Hypokalemia is a potential risk in DKA but typically arises from the shift of potassium from the extracellular to intracellular space during treatment, especially with insulin administration, not from the use of hypotonic fluids.
D. Metabolic acidosis is a hallmark of diabetic ketoacidosis itself and is caused by the accumulation of ketones. It is not caused by hypotonic fluid replacement.