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Nurses Response: DKA results from when the body is no longer producing insulin. Our cells
need glucose and fatty acid to produce energy (ATP). In order to use glucose, it has to have
insulin. Glucose sits outside the cell and in order for glucose to get inside, it needs to have
insulin.. Without glucose, the cells breakdown fatty acids for its energy. Well, fatty acids leads to
acidosis, which as a result leads to hyperkalemia (high potassium), and elevated glucose level
because since glucose cannot get into the cell it is rising in our blood because it cannot get into
our cells to use it. So as the glucose rises, it leads to osmotic diuresis which forces pressure on
your kidneys leading to renal failure and increase creatinine. Two things are happening: We are
breaking down fatty acids which leads to acidosis and we are not using glucose that's leading to
Nurses Response: Normal blood glucose levels should range from 70- 110 mg/dL. When blood
glucose concentration exceeds 250- 300 mg/dl, generally, DKA has occurred.
Nurses Response: Electrolytes are vital for the normal functioning of our body. They include
sodium, potassium calcium and bicarbonate. High blood sugar causes excessive urination and
spillage of sugar into the urine. This leads to loss of body water and dehydration as well as loss
of important electrolytes, including elevated sodium and potassium. The level of another
electrolyte, bicarbonate, also falls as the body tries to compensate for excessively acidic blood
2
along with low Ph, acidosis. Normal Potassium (3.5-5.0), Sodium (135-145) Bicarbonate (22-28)
pH( 7.35-7.45)
Nurses Response: Serum pH falls below 7.35 (acidosis). Bicarbonate level falls below
15mEq/L, resulting in Metabolic acidosis and hyperglycemia and Kussmauls respiration (deep
labored breathing).
Potassium and sodium are the main electrolytes that are monitored in the acute
stages of DKA because potassium often leaves the intracellular space and sodium is
monitored because insulin may cause hypokalemia.
h. How are electrolyte imbalances corrected? How rapidly is this accomplished? Why?
How are complications of electrolyte replacement prevented?
Electrolyte imbalances are corrected by IV therapy with potassium chloride.
Potassium should be given 1-2 hours after insulin therapy starts.
j. How are acid-base disturbances corrected? How quickly is this accomplished? Why?
How are complications of acid-base correction prevented?
Acid-base disturbances are corrected by fluid replacement and also through insulin
therapy. This is accomplished slowly in order to prevent hypokalemia. Prevention
includes carefully assessing electrolyte levels, ABGs, and intake and output.
6. Define the following terms and describe how the results of each are used: anion gap,
serum osmolality and venous CO2.
Anion gap: the difference between electrolytes, cations anions = anion gap.
Serum osmolality measures the electrolytes, urea, and glucose in the blood to find fluid
and electrolyte imbalances in the body.