Progressive Care Nursing Certification (PCCN) Practice Exam

What is a common initial lab finding in a patient with diabetic ketoacidosis?

1. Decreased sodium levels

2. Elevated liver enzymes

3. Increased potassium levels

4. Increased calcium levels

The correct answer is: Increased potassium levels

In the context of diabetic ketoacidosis (DKA), the common initial lab finding is indeed increased potassium levels. This phenomenon occurs because, in DKA, there is an accumulation of ketoacids, which leads to a shift of potassium from inside the cells to the extracellular space. As acidosis develops, hydrogen ions enter the cells to correct the pH, displacing potassium, and causing increased levels in the blood. While the total body potassium may be decreased due to urinary losses and the underlying diabetic condition, the lab values often reveal hyperkalemia at the time of diagnosis due to this redistribution effect. It is critical to monitor potassium levels closely in DKA patients because as treatment begins, especially with insulin therapy, potassium levels can drop quickly, leading to potential cardiac complications. The other options do not represent typical initial lab findings in DKA. Sodium may appear decreased, but this is often due to dilutional effects rather than a true loss. Elevated liver enzymes are not characteristic of DKA, but rather may indicate hepatic injury or other processes. Increased calcium levels are not usually associated with DKA and do not have a direct correlation in this condition. Thus, increased potassium levels stands out as the key initial lab finding.