A nurse is assessing a client who has thyrotoxicosis after taking high doses of levothyroxine. Which of the following manifestations should the nurse expect?

Choice A reason: Blood glucose below 40 mg/dL indicates hypoglycemia, not DKA, which is characterized by hyperglycemia (typically >250 mg/dL) due to insulin deficiency, driving ketogenesis. Hypoglycemia may occur during DKA treatment but is not an expected initial manifestation of the condition.

Choice B reason: Malignant hypertension is not a feature of DKA. DKA may cause hypotension from dehydration due to osmotic diuresis, not extreme hypertension. Malignant hypertension is associated with other conditions, like renal disease, making this an incorrect manifestation for DKA.

Choice C reason: Kussmaul breathing, rapid and deep respirations, is a hallmark of DKA, compensating for metabolic acidosis (pH <7.35) from ketone accumulation. This respiratory effort lowers PaCO2 to buffer hydrogen ions, making it a key clinical sign expected in DKA patients.

Choice D reason: Fetor hepaticus, a musty breath odor, is associated with liver failure, not DKA. DKA causes fruity breath from acetone, a ketone byproduct of fat metabolism, making fetor hepaticus an incorrect manifestation for this metabolic condition.

Choice A reason: Hypocalcemia is not a primary concern in DKA. While calcium levels may be affected by acidosis or treatment, hypokalemia is more critical due to insulin-driven potassium shifts and diuresis, posing greater risk for arrhythmias, making this a less urgent electrolyte imbalance to monitor.

Choice B reason: Hyponatremia may occur in DKA due to osmotic shifts from hyperglycemia, but it is less critical than hypokalemia. Potassium depletion from insulin therapy and diuresis poses immediate risks like arrhythmias, making hyponatremia a secondary concern in DKA management.

Choice C reason: Hypokalemia is a critical electrolyte imbalance in DKA, as insulin therapy drives potassium into cells, and osmotic diuresis causes urinary loss. Low potassium (below 3.5 mEq/L) risks cardiac arrhythmias and muscle weakness, requiring close monitoring and replacement to ensure patient safety during treatment.

Choice D reason: Hypomagnesemia may occur in DKA but is less common and critical than hypokalemia. Magnesium loss via diuresis is possible, but potassium’s role in cardiac and muscle function makes its monitoring more urgent to prevent life-threatening complications during DKA treatment.