Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive

Case Study: Management of Diabetic Ketoacidosis (DKA) and Hyperkalemia

Course: Advanced Medical-Surgical Nursing (NURS 400-level/600-level)

Due Date: October 20, 2025

Weight: 25% of Final Grade

Format: Individual Case Study Analysis Paper (1,500–1,800 words, excluding title page and references)

Scenario

Mr. Sweet, a 38-year-old male with a history of Type 1 diabetes, is admitted to the Emergency Department (ED) unresponsive. He reports feeling unwell for the last three days with flu-like symptoms and has not been adhering strictly to his insulin regimen.

Initial Assessment Data:

• Vitals: HR 116 (Tachycardic), BP 107/64 (Hypotensive), RR 36 Deep and rapid (Kussmaul respirations), Temp 101.5°F (Febrile).
• Labs:
  • Blood Glucose: 532 mg/dL
  • Potassium (K+): 7.2 mEq/L (Hyperkalemic)
  • Arterial Blood Gas (ABG): pH 7.08 (Acidotic), Bicarbonate (HCO3−​) 12 mEq/L (Low), pCO2​ 28 mmHg (Low)

Assignment Instructions

Write an evidence-based case study analysis paper focusing on the immediate and initial management of Mr. Sweet’s critical condition. Your paper must integrate concepts of pathophysiology, pharmacology, fluid and electrolyte balance, and evidence-based nursing interventions.

Your analysis must address the following points:

1. Pathophysiology and Diagnosis:
   • Identify Mr. Sweet’s primary medical diagnosis and the corresponding acid-base disturbance, providing a detailed explanation of the underlying pathophysiology for each, linking the clinical and lab data (e.g., $\text{BG}$ 532, $\text{pH}$ 7.08, $\text{RR}$ 36) to the disease process.
   • Specifically discuss the physiological mechanism contributing to his hyperkalemia (K+ 7.2 $\text{mEq}/\text{L}$) in the context of his acid-base status.
2. Priority Interventions and Rationale:
   • Analyze and prioritize the initial three to five expected medical and nursing interventions upon admission (e.g., intravenous fluids, insulin, electrolyte management).
   • Provide a strong, evidence-based rationale for each intervention, detailing the expected physiological effect (e.g., how the intervention addresses the $\text{pH}$, blood glucose, K+, or hemodynamic instability).
   • Address the management of his severe hyperkalemia (K+ 7.2 $\text{mEq}/\text{L}$) and the specific pharmacological or non-pharmacological interventions used to acutely lower the potassium level, explaining the mechanism of action.
3. Ongoing Monitoring and Complication Prevention:
   • Detail the essential parameters for continuous monitoring during the initial 24 hours of treatment (e.g., neurological status, labs, cardiac function).
   • Identify at least two potential life-threatening complications that can occur during the treatment phase of his condition (e.g., cerebral edema, hypokalemia) and outline specific preventative and monitoring strategies for each.

Submission Requirements

• Style: Use professional academic writing.
• Citations: Follow the current APA format (7th edition) for all in-text citations and the References list.
• Sources: Use a minimum of five (5) credible, scholarly sources published within the last five (5) years (2020–2025).

References

1. Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2025). Hyperglycemic Crises in Adult Patients with Diabetes. Diabetes Care, 48(2), 488–497.
2. Gosmanov, A. R., & Kitabchi, A. E. (2024). Hyperglycemic Crises: Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS). In G. E. Umpierrez (Ed.), Endocrinology and Metabolism Clinics of North America: Critical Care Endocrinology (53(3), pp. 581–595).
3. Kovesdy, C. P., Furth, S. L., & Zoccali, C. (2023). Hyperkalemia: An Interdisciplinary Approach to Management. Clinical Journal of the American Society of Nephrology, 18(5), 789–798.
4. Pham, M. V., & Goldstein, R. E. (2021). Fluid and Electrolyte Management in Acute Metabolic Acidosis. Critical Care Nursing Clinics of North America, 33(4), 487–498.
5. Malone, K. R., & Sullivan, L. M. (2019). Nursing Management of Type 1 Diabetes and DKA: A Review of Current Guidelines. Journal of Nursing Practice and Research, 14(1), 12–19.

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Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive. He has a history of Type 1 diabetes and has been sick for the last 3 days. On admission his Blood sugar is 532, Potassium is 7.2 and ABG results include pH 7.08, Bicarb 12, and CO2 28. His VS are HR 116, BP 107/64, RR 36 Deep and rapid, and Temp 101.5. Answer the following questions:

What interventions do expect to be ordered for Mr. Sweet? Why?
What type of acid-base disturbance does he have?
What do you think is Mr. Sweet’s Medical Diagnosis?
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Interventions:
Insulin administration: Since Mr. Sweet has a history of Type 1 diabetes and has a high blood sugar level of 532, insulin administration is expected to be ordered to lower his blood sugar levels and prevent the development of diabetic ketoacidosis (DKA).
IV fluid resuscitation: His low blood pressure (BP 107/64) and elevated heart rate (HR 116) suggest that he may be dehydrated, so IV fluid resuscitation is likely to be ordered to correct fluid volume deficits.

Electrolyte replacement therapy: The low potassium level of 7.2 may be due to insulin-induced shift of potassium into cells and can lead to life-threatening cardiac dysrhythmias. Hence, electrolyte replacement therapy with potassium supplementation is expected to be ordered.
Monitoring: Vital signs monitoring, including continuous monitoring of blood glucose levels and electrolyte levels, is also expected to be ordered.

Acid-base disturbance: Mr. Sweet’s ABG results indicate a metabolic acidosis with a low pH of 7.08 and a low bicarbonate level of 12. The metabolic acidosis is likely due to elevated levels of ketones in the blood (a hallmark of DKA), which causes a shift in the balance of acid-base in the body. The elevated levels of ketones lead to an increase in the concentration of hydrogen ions in the blood, which results in a lower pH. The low bicarbonate level of 12 is a compensatory response to the metabolic acidosis, which helps to maintain the pH within a normal range. In a metabolic acidosis, the body tries to restore the acid-base balance by retaining bicarbonate or producing more bicarbonate, but in this case, it appears that the compensatory response is not enough to bring the pH back to a normal range.