Exhibits

Which other labs would be helpful for the treatment of diabetic ketoacidosis (DKA)? Select all that apply.

A. White blood cell differential. Although infection is a common precipitating factor for DKA, an elevated WBC count is common in DKA due to stress, dehydration, and inflammation rather than infection itself. While a WBC differential may be done if infection is suspected, it is not a primary test for DKA management.
B. Hemoglobin A1C. Hemoglobin A1C (HbA1c) reflects long-term glucose control (past 2-3 months) but does not provide immediate information about the current metabolic status or severity of DKA. While it may be useful in assessing overall diabetes management, it is not essential for acute DKA treatment.
C. Serum electrolytes. Patients with DKA experience significant electrolyte imbalances, particularly potassium depletion due to osmotic diuresis and insulin deficiency. Monitoring serum sodium, potassium, and bicarbonate is crucial for guiding fluid and electrolyte replacement therapy. Potassium levels may appear normal or high initially due to acidosis but typically drop with insulin administration.
D. Urine culture. A urine culture is only indicated if a urinary tract infection (UTI) is suspected as a trigger for DKA. However, routine urine culture is not required in every case of DKA unless there are symptoms of infection such as fever, dysuria, or pyuria.
E. Anion gap. DKA is a form of high anion gap metabolic acidosis, caused by the accumulation of ketones. The anion gap (AG) is calculated as (Na⁺ - [Cl⁻ + HCO₃⁻]), with a value >12 mEq/L indicating metabolic acidosis. Monitoring the anion gap helps assess the severity of acidosis and guide treatment progress, as a decreasing anion gap suggests resolution of ketosis.
F. Urine ketones. Urine ketone testing helps confirm the presence of ketoacidosis, particularly in the initial stages of DKA diagnosis. While serum beta-hydroxybutyrate is a more accurate indicator of ketone levels, urine ketones remain useful for initial screening and monitoring treatment response as they decrease with appropriate management.

Calculation:

Calculate the dopamine dose in mcg/min:

Dose = 2 mcg/kg/min

Weight = 60 kg

Dose per minute = 2 mcg/kg/min × 60 kg

= 120 mcg/min

Calculate the dopamine dose in mcg/hour:

Dose per hour = 120 mcg/min × 60 min/hour

= 7200 mcg/hour

Convert mcg to mg:

Dose per hour = 7200 mcg/hour / 1000 mcg/mg

= 7.2 mg/hour

Calculate the concentration of dopamine in the IV bag:

Dopamine: 400 mg

Solution: 500 mL

Concentration = 400 mg / 500 mL

= 0.8 mg/mL

Calculate the infusion rate in mL/hour:

Dose per hour: 7.2 mg/hour

Concentration: 0.8 mg/mL

Infusion rate = 7.2 mg/hour / 0.8 mg/mL

= 9 mL/hour