Diabetic Ketoacidosis Flashcards
What are signs and symptoms of hypoglycemia?
- Reduced cognition
- Tremors
- Diaphoresis
- Weakness
- Hunger
- Headache
- Irritability
- Seizure
What are signs and symptoms of hyperglycemia?
- Polyuria
- Polydipsia
- Dehydration
- Fatigue
- Fruity odor to breath
- Kussmaul breathing
- Weight loss
- Hunger
- Poor wound healing
What are the causes and characteristics of hyperglycemic crisis known as diabetic ketoacidosis?
- Results from absolute or relative deficiency in insulin
- Potentially severe, sometimes life-threatening
- Elevated total ketones (ketosis)
- Metabolic acidosis
- Uncontrolled hyperglycemia
What are clinical features of DKA?
- Hyperglycemia
- Dehydration and electrolyte loss
- Acidosis (Metabolic)
- Manifestations include polyuria, polydipsia, blurred vision, weakness, headache, anorexia, abdominal pain, nausea, vomiting, acetone breath, hyperventilation with Kussmaul respirations, and mental status changes
What are some patient and precipitating factors?
- Type 1 diabetes
- younger age (<45)
- non-white
- female
- infection
- severe stress (precipitates imbalance in glucose-insulin relationship)
- inadequate insulin dosing
- undiagnosed and untreated diabetes
- Alcohol abuse and certain drugs
What leads to metabolic acidosis in DKA?
- Lack of insulin leads to lipolysis, and the liver converts the free fatty acids into ketone bodies
- Ketone bodies are acids; their accumulation in circulation leads to metabolic acidosis
What are manifestations of hyperglycemia?
- Polyuria and polydipsia,
- blurred vision
- weakness
- headache,
- hypotension with a weak, rapid pulse (intravascular volume depletion)
What are manifestations of ketosis & acidosis?
- GI symptoms (anorexia, nausea, vomiting, and abdominal pain)
- Acetone breath (elevated ketones)
- Kussmaul Respirations (compensation for acidosis)
What are manifestations of osmotic diuresis?
- LOC changes
- Dehydration
- Elevated BUN & Creatinine
- Electrolyte Abnormalities
What does osmotic diuresis lead to?
Polyuria, then dehydration, and marked electrolyte loss
How do you assess for DKA?
- Blood glucose levels vary between 16.6 mmol/L and 44.4 mmol/”
- Severity of DKA is not related to blood glucose level
- Electrolytes vary according to water loss and level of hydration
- Ketosis
- Ketone bodies in blood and urine
- Anion gap, nausea and vomiting
- Low serum bicarbonate and low pH (6.8 - 7.3)
- May have low PCO2 (reflects respiratory compensation through Kussmaul breathing)
What are some strategies to prevent DKA when person with diabetes is ill?
- Don’t eliminate insulin with nausea and vomiting
- When ill, try to take fluids in q 1 h and test blood glucose and urine ketones q 3-4 h
Ketosis – Which imbalance is it?
metabolic acidosis
What is the nurse’s role in caring
for the patient with DKA?
- Monitoring fluid and electrolyte status and CBGs
- Administer fluids, insulin and other medications
- Prevent fluid overload
- Monitor urine ourput
- Monitor ECG for dysrhythmias
- Vital signs, arterial blood gases (documentation)
- Assess underlying cause
- Patient education
What treatment is involved with DKA?
Rehydrate with IV fluid (may need 6-10 L of fluid; usually give normal saline initially, then 1/2 saline; eventually give D5W with insulin)
Reverse acidosis and restoration of electrolyte balance
Continuous IV infusion of regular insulin
Note: Rehydration leads to increased plasma volume and decreased K+; insulin enhances the movement of K+ from extracellular fluid into the cells
