DKA is caused by an absence or markedly inadequate amount oI insulin. This deIicit results in disorder in the metabolism oI carbohydrate, protein and Iat. Without insulin, the amount of glucose entering the cells is reduced.
DKA is caused by an absence or markedly inadequate amount oI insulin. This deIicit results in disorder in the metabolism oI carbohydrate, protein and Iat. Without insulin, the amount of glucose entering the cells is reduced.
DKA is caused by an absence or markedly inadequate amount oI insulin. This deIicit results in disorder in the metabolism oI carbohydrate, protein and Iat. Without insulin, the amount of glucose entering the cells is reduced.
DKA is caused by an absence or markedly inadequate amount oI insulin. This deIicit in available insulin results in disorder in the metabolism oI carbohydrate, protein and Iat.
The three main clinical Ieatures/maniIestations oI Diabetic Ketoacidosis (DKA) are based on the Iollowing concepts: ) Hyperglycemia 2) dehydration and electrolyte loss 3) acidosis. lood glucose levels range Irom 300 to 800 mg/dL. Low serum bicarbonate and a low pH are present.
It is a liIe-threatening complication oI DM type I. this is due to severe insulin deIiciency.
2. Risk Iactors
4 !atient with Type I diabetes mellitus are at risk to develop DKA. 4 !ersons who are Irequently stressed out or due to stress-induced by surgery and 4 persons with Irequent or severe illness/inIection are also at risk oI developing DKA.
3. Causes
&nderdose or missed dose oI insulin Illness or inIection vereating $tress, surgery &ndiagnosed and untreated type I DM.
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. !athophysiology
Without insulin, the amount oI glucose entering the cells is reduced, and production and release oI glucose by the liver is increased. oth Iactors lead to hyperglycemia. In an attempt oI the body to get rid oI the excess glucose, the kidneys excrete the glucose along with water and electrolytes. This osmotic diuresis, which is characterized by excessive urination (polyuria), leads to dehydration and marked electrolytes loss.
Lack of lnsulln lncreased breakdown of faLs O ecreased uLlllzaLlon of glucose by muscles faL and llver O lncreased producLlon of glucose by llver Pyperglycemla lncreased faLLy aclds lncreased keLones bodles O ceLone breaLh O 9oor appeLlLe O nausea O -ausea O IomlLlng O bdomlnal paln cldosls lncreaslng rapldly resplraLlons 9olyurla 8lurred vlslon O Jeakness O Peadache ehydraLlon lncreased LhlrsL (polydlpsla)
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. Clinical maniIestations
Acetone breath (Iruity odor) Anorexia, nausea, vomiting, abdominal pain !olyuria !olydipsia lurred vision, weakness and headache rthostatic hypotension (drop in systolic blood pressure oI 20 mm Hg or more on changing Irom reclining to standing position) rank hypotension with a weak, rapid pulse Mental status changes Kussmaul`s respirations
6. Diagnostic test speciIic to the disease
asting lood $ugar ($) Iasting is deIined as no caloric intake Ior at least eight hours; this include no Iood, juices, milk; only water is allowed (N!).
Two-hour blood sugar test perIormed two hours aIter using 7 g glucose dissolved in water or aIter a good meal. ral Glucose Tolerance Test (GTT) is not recommended Ior routine clinical use nor screening purposes. lood glucose monitoring Check Ior Electrolytes imbalances
7. Medical Management
In addition to treating hyperglycemia, management oI DKA is aimed at correcting dehydration, electrolyte loss, and acidosis.
Rehydration Treat dehydration with N$$ 0.9 or 0. rapid IV as prescribed. DN$ or dextrose in 0. saline when the blood glucose level reaches 20 to 300 mg/dL.
Restoring electrolytes Administer !otassium replacements
Reversing acidosis Ketone bodies (acids) accumulates as a result oI Iat breakingdown. It is reversed by insulin. InIuse intravenously at a slow continuous rate.
9. Nursing management and Non-pharmacologic treatments
Monitoring Iluid, electrolyte and hydration status Monitor blood glucose level Administer Iluids, insulin, and other medications !revent Iluid overload Monitor intake and output accurately Vital signs monitoring AG results monitoring and reporting to the attending physician Assess mental status and breath sounds Check ECG reading and make sure that there are no signs oI hyperkalemia (tall and peaked or tented T waves) Make sure that laboratory values oI potassium are normal or approaching normal. Make sure that the patient is urinating. (no renal shutdown) Initiate reIerrals Ior home care and outpatient diabetes education to ensure patient continued recovery.
10.Collaborative management
Maintain patent airway Administer xygen therapy as prescribed Treat dehydration with 0.9 N$$ or 0. rapid as prescribed.
11.Nursing Care !lan
Risk for fluid volume deficit related to polyuria and dehydration
Imbalanced nutrition related to imbalance of insulin, food, and physical activity
atigue related to decreased metabolic energy production and insufficient insulin as evidenced by overwhelming lack of energy, decreased performance and disinterest in surrounding.
12.Diet
O Collaborate with the dietician and the physician.
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13.Methods oI !revention and Contro
or prevention oI DKA related to illness patients must be taught '$ICK DAY rules Ior managing their diabetes when ill.
4 Guidelines to ollow During !eriods oI Illness (~SICK DAY RULES)
O Take insulin or oral antidiabetic agents as usual.
O Test blood glucose and test urine ketones every 3 to hours.
O Report elevated glucose level (~300 mg/dL|16.6mmol/L| or as otherwise speciIied) or urine ketones to your health care provider.
O II you take insulin, you may need supplemental doses oI regular insulin every 3 to h.
O II you cannot Iollow your usual meal plan, substitute soIt Ioods six to eight times per day.
O II vomiting, diarrhea, or Iever persists, take liquids every to 1 hour to prevent dehydration and to provide calories.
O Report nausea , vomiting, and diarrhea to your health care provider, because extreme Iluid loss may be dangerous.
O II you are unable to retain oral Iluids, you may require hospitalization to avoid diabetic ketoacidosis and possible coma.
The most important concept to teach patients is not to eliminate insulin doses when nausea and vomiting occur.
lood glucose and urine ketones must be Irequently assessed.