A 24-year-old client with type 1 diabetes has been vomiting for 2 days. Findings: blood glucose 486 mg/dL, arterial pH 7.21, bicarbonate 12 mEq/L, deep and rapid respirations, fruity breath odor, serum potassium 5.6 mEq/L, and positive serum ketones. Complete the bowtie: the condition the client is most likely experiencing, 2 actions to take, and 2 parameters to monitor.

Hyperglycemia, metabolic acidosis (low pH and bicarbonate), Kussmaul respirations and ketones mean DKA. HHS has little or no ketosis. Treatment starts with isotonic fluids and IV regular insulin. Insulin drives potassium into cells, so potassium can fall quickly even though it starts high; monitor it closely along with hourly glucose. Potassium is never given by IV push, and dextrose is added only once glucose falls (about 200–250 mg/dL), not as a push.