You lob a nuke at the DPRK and China will go ape****, whether the DPRK used one first or not. Chances are, if the DPRK DID use a nuke obviously then it would isolate itself immediately in the international community (well...more than it already is) and chances are that Beijing would co-operate in a limited sense in the removal of Kim Jong-il or whoever is in charge at the moment, probably in return for a return to the status quo with a Chinese puppet in charge of the DPRK. Having the Chinese on side would go a long way to bringing any conflict to a swift close with minimal allied casualties.
I suspect, given the closeness between Tehran and Pyongyang, that Iran will act up if the DPRK does, to try and stretch the US's response between the two countries plus Afghanistan.
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