A client who has Addison's crisis is receiving dextrose 5% in normal saline intravenously. The client asks the nurse why this type of solution is used. Which of the following responses should the nurse give?

Choice A reason:

This is incorrect because dextrose 5% in normal saline is a hypertonic solution that will increase the blood sugar level, not lower it. Patients with Addison's crisis have low cortisol levels, which can impair glucose metabolism and cause hypoglycemia, so they need glucose supplementation.

Choice B reason:

This is partially correct because dextrose 5% in normal saline will provide some nutrition with glucose, but this is not the main reason for using this solution in Addison's crisis. Patients with Addison's crisis have low aldosterone levels, which can cause hyponatremia and hypovolemia, so they need sodium and fluid replacement.

Choice C reason:

This is correct because dextrose 5% in normal saline will correct the low sodium level caused by aldosterone deficiency in Addison's crisis. Sodium is essential for maintaining blood pressure, fluid balance, and nerve and muscle function. Dextrose 5% in normal saline will also increase the blood volume and prevent dehydration and shock.

Choice D reason:

This is partially correct because dextrose 5% in normal saline will increase the blood volume, but this is not the only solution that can do that. Other isotonic or hypertonic solutions can also expand the intravascular space. Dextrose 5% in normal saline is preferred in Addison's crisis because it also provides glucose and sodium, which are both deficient in this condition.

Choice A reason:

Decreased serum osmolarity. This is the correct answer because the goal of therapy for diabetic ketoacidosis (DKA) is to restore fluid and electrolyte balance, correct acidosis, and lower blood glucose levels. 0.45% sodium chloride (1/2 normal saline) is a hypotonic solution that helps to rehydrate the intracellular and extracellular compartments and reduce the serum osmolarity, which is elevated in DKA due to hyperglycemia and dehydration.

Choice B reason:

Increased urine specific gravity. This is incorrect because urine specific gravity reflects the concentration of solutes in the urine. In DKA, urine specific gravity is usually high due to osmotic diuresis caused by hyperglycemia and ketonuria. Effective therapy for DKA should lower the urine specific gravity as the blood glucose level and hydration status improve.

Choice C reason:

Decreased serum bicarbonate level. This is incorrect because serum bicarbonate level reflects the metabolic component of acid-base balance. In DKA, serum bicarbonate level is low due to increased production of ketoacids that consume bicarbonate as a buffer. Effective therapy for DKA should increase the serum bicarbonate level as the acidosis is corrected by insulin and fluid administration.

Choice D reason:

Increased serum potassium level. This is incorrect because serum potassium level is affected by several factors in DKA, such as insulin deficiency, acidosis, osmotic diuresis, and fluid therapy. In DKA, serum potassium level may be normal or high initially due to the shift of potassium from the intracellular to the extracellular space, but the total body potassium is depleted. Effective therapy for DKA should normalize the serum potassium level by replacing potassium losses and correcting the factors that cause potassium shift.