Registered Nurse (RN) Endocrine Licensure Exam

Which of the following is NOT a medical treatment for DKA and HHNS?

1. A. IV regular insulin

2. B. Isotonic fluids

3. C. Bicarbonate

4. D. IV potassium solution

The correct answer is: C. Bicarbonate

Bicarbonate is not typically utilized as a medical treatment for Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic State (HHNS). The primary methods for treating these acute conditions focus on addressing the underlying metabolic problems, which includes managing blood glucose levels, restoring fluid balance, and correcting electrolyte imbalances. In cases of DKA and HHNS, intravenous regular insulin is administered to lower blood glucose levels effectively and halt ketogenesis, while isotonic fluids (like normal saline) are essential for rehydration to restore intravascular volume and correct electrolyte abnormalities. IV potassium solutions are frequently necessary because both DKA and HHNS can lead to significant shifts in potassium levels due to insulin treatment, which drives potassium back into the cells. Bicarbonate therapy has a very specific and limited role, primarily reserved for severe acidosis, typically with pH levels below 6.9, as its use in metabolic acidosis associated with DKA is generally not recommended. This is due to potential risks such as the development of hypokalemia and paradoxical brain acidosis. Thus, it does not form part of the standard treatment protocol for DKA and HHNS.