DKA

Question 1

DKA
Risk factor?

Answer 1

Inadequate insulin dosing
Fear of weight gain
Hypoglycemia
Stress associated with chronic diagnosis
Infection
Alcohol or drugs

Question 2

How body react when insulin deficiency occurs?
Altered carbohydrate metabolism

Answer 2

Inc gluconeogenesis(synthesis of glucose)
Inc glycogenolysis
Inc lipolysis
Dec glucose uptake by liver,muscle and fat
Metabolic acidosis

Question 3

What will happen when inc lipolysis?

Answer 3

Inc free fatty acido→ Inc ketones →　cause ketomemia and ketonuria

Question 4

Clinical manifestations

Answer 4

Dehydration
Tachycardia
Orthostatic hypotension
Lethargy, weakness
Abdominal pain
Anorexia
Vomiting
Kaussmaul respirations(fast,deep)
Fruity acetone breathe(nail polish)

Question 5

Lab Findings
a) glucose
b) pH
c) HCO3
d) urine

Answer 5

a) > 250
b) pH <7.30
normal 7.35-7.45
c) <15
d) Ketones in the urine

Question 6

Nursinng interventions

Answer 6

IV fluids
-dehydration and hypovolemia
Insulin IV
-reduce counterregulatory hormones
(cortisol,adrenaline, glucogan)
-disrupt ketone production
Give potassium
mantaine electrolytes

Question 7

HHS
Risk factors

Answer 7

Inadequate insulin(Same as DKA)
Infection(Same as DKA)
Dehydration
Restricted water intake caused by illness or immobilization
Altered thirst response in elderly
Enteral feeds without water supplementation

Question 8

Difference between DKA and HHS?
a) Generate enough insulin?
b) Dehydration?
c) Neurological manifestations?
d) Counterregulatory hormone released?

Answer 8

a) HHS has the ability to generate enough insuline to prevent metabolic acidosis
b) Inc dehydration
c) Neurological manifestations occur b/c of ↑ serum osmolality
d) Dec counterregulatory hormone released

Question 9

Clinical manifestations

Answer 9

Dehydration
Tachycardia
Tachypnea
Hypotension
Aphasia
Altered mental status
Seizures
Hemiparesis – weakness to 1 side of body

Question 10

HHS
Lab findings
a) BS
b) serum osmolality
c) Ketone

Answer 10

a) > 400 (often >700)
b) ↑ in serum osmolality(dehydration)
c) Absent ketone bodies

Question 11

DKA and HHS
which labs?

Answer 11

Serum glucose
Serum electrolytes with BUN & creatinine
Complete blood count (CBC) with differential
Urinalysis and urine ketones by dipstick
Plasma osmolality (Posm)
Serum ketones (if urine ketones are present)
Blood gas- ABG or VBG
EKG

Question 12

DKS and HHS
Administer Fluids
a) For the first hour?
b) Depending on Na level, may change to?
c) When BS <200, change to?

Answer 12

a) 1L 0.9% NS
b) 0.45% half NS at 250-500 mL/hr
c) D5 ½ NS

Question 13

DKA and HHS
Administer regular insulin
a) continuous infusion?
b) When BS <200 -250?
c) Too rapid admin IV fluids & rapid lowering of BS cause?
d) check BS every what hour?

Answer 13

a) 0.1 units/kg IV bolus
b) Dec insulin rate to 0.05 units/kg/hr
c) cerebral edema
mental staus change,notify provider!
d) Q1h

Question 14

DKA and HHA
Administer Potassium
a) If K+ >5.0 mEq/L
b) If K+ <3 mEq/L

Answer 14

a) no supplement
b) hold insulin, admin supplements until K > 3.3

Question 15

Administer Sodium Bicarbonate
a) Only for DKA, why?
b) If arterial pH <7.0 or bicarb <5?
c) If pH >7.0

Answer 15

a) since acidosis doesn’t occur with HHS
b) administer prescribed dose
c) no bicarb