A nurse is caring for a newborn who was born to a mother with diabetes mellitus.

The nurse should monitor the newborn for which of the following signs of hypoglycemia?

Choice A reason:

Chloride is not a major electrolyte that is affected by diabetic ketoacidosis (DKA) Chloride levels may be low, normal or high depending on the acid-base status and hydration of the client. Therefore, chloride is not a priority electrolyte to monitor for signs of imbalance.

Choice B reason:

Phosphate is also not a major electrolyte that is affected by DKA. Phosphate levels may be low due to insulin therapy or high due to renal impairment, but these are not directly related to DKA. Therefore, phosphate is not a priority electrolyte to monitor for signs of imbalance.

Choice C reason:

Bicarbonate is a major electrolyte that is affected by DKA. Bicarbonate levels are low in DKA due to metabolic acidosis caused by the accumulation of ketones in the blood. Low bicarbonate levels can lead to symptoms such as nausea, vomiting, abdominal pain, confusion and coma. Therefore, bicarbonate is a priority electrolyte to monitor for signs of imbalance.

Choice D reason:

Sulfate is not a major electrolyte that is affected by DKA. Sulfate levels are not routinely measured in clinical practice and have no significant role in DKA. Therefore, sulfate is not a priority electrolyte to monitor for signs of imbalance.

Choice E reason:

Potassium is a major electrolyte that is affected by DKA. Potassium levels can be high or low in DKA depending on several factors such as insulin therapy, fluid replacement, renal function and acid-base status. High or low potassium levels can cause cardiac arrhythmias, muscle weakness, paralysis and respiratory failure. Therefore, potassium is a priority electrolyte to monitor for signs of imbalance.

The correct answer is choice B. Hypoglycemia.

The newborn is at risk for hypoglycemia because of the maternal diabetes and the prematurity.Maternal diabetes causes fetal hyperinsulinism, which persists after birth and lowers the blood glucose level of the newborn.Prematurity causes inadequate glycogen stores and immature enzyme function, which also contribute to hypoglycemia.Hypoglycemia can cause symptoms such as tachycardia, cyanosis, seizures, and apnea.

Choice A is wrong because hyperglycemia is unlikely in a newborn with hyperinsulinism and deficient glycogen stores.

Choice C is wrong because hypertension is not a common complication of maternal diabetes or prematurity in newborns.

Choice D is wrong because hypothyroidism is not related to maternal diabetes or prematurity.Hypothyroidism can cause symptoms such as lethargy, poor feeding, jaundice, and hypotonia.

Normal ranges for blood glucose levels in newborns vary depending on the age, weight, and feeding status of the baby.

Generally, a level below 40 mg/dL (2.2 mmol/L) in symptomatic term newborns, below 45 mg/dL (2.5 mmol/L) in asymptomatic term newborns between 24 hours and 48 hours of life, or below 30 mg/dL (1.7 mmol/L) in preterm newborns in the first 48 hours is considered hypoglyc