Progressive Care Nursing Certification (PCCN) Practice Exam

What is the initial dangerous electrolyte abnormality found in diabetic ketoacidosis (DKA)?

1. Hypernatremia

2. Hyponatremia

3. Hypocalcemia

4. Hyperkalemia

The correct answer is: Hyperkalemia

In diabetic ketoacidosis (DKA), hyperkalemia is often the initial dangerous electrolyte abnormality. This occurs due to a combination of factors associated with the condition, including the acidosis that develops and insulin deficiency. During DKA, the body experiences an increase in hydrogen ions in the blood, leading to a shift of potassium ions out of the cells as the cells attempt to buffer the acidosis. Moreover, the lack of insulin promotes the extracellular movement of potassium, compounding the rise in serum potassium levels. This elevated potassium can initially present as a falsely high level due to the shift of potassium from inside the cells to the bloodstream. However, it is critical to monitor potassium levels closely because, as therapy such as insulin administration is initiated, potassium levels can drop rapidly, risking hypokalemia. Thus, recognizing hyperkalemia as an early electrolyte disturbance in DKA is important in guiding treatment and preventing complications. The other options represent different electrolyte imbalances, but they do not reflect the dangerous initial changes seen in DKA. For instance, hypernatremia and hyponatremia can occur due to various factors in the context of DKA, particularly related to fluid shifts and dehydration. Hypocalcemia may also be present but is