DKA Flashcards
S/S: - Polyuria, Polyphagia, Polydipsia, Blurred vision, Hyperglycemia, Delayed wound healing, hyperglycemia, warm dry skin, confusion, drowsiness, lethargy, Tachycardia
Hyperglycemia Complications:
Metabolic Acidosis due to increase in ketones/break down of fat.
❖ Caused by profound deficiency of insulin
DIABETIC KETOACIDOSIS
Characterized by
❖ Hyperglycemia
❖ Ketosis – Acetone breath (fruity alcohol breath), poor appetite, nauseua/vomiting.
❖ Acidosis (Metabolic Acidosis- nausea/vomiting/abdominal pain/rapid respirations/Kussmaul breathing)
❖ Dehydration (due to nausea/vomiting)
❖ Most likely to occur in type 1 diabetes
DKA:
Illness
Infection
inadequate insulin dose
stress
undiagnosed Type 1 diabetes
poor self management
Causes of DKA
Dehydration
-Poor skin turgor
-Dry mucosa membrane
-Orthostatic hypotension
-Tachycardia
DKA clinical manifestation/ Assessment
❖ Lethargy and weakness early
❖ Skin dry and loose; eyes soft and sunken
❖ Abdominal pain, anorexia, nausea/vomiting
❖ Kussmaul respirations
❖ Sweet, fruity breath odor
❖ Blood glucose level of 250 mg/dL or higher
❖ Blood pH lower than 7.30
❖ Serum bicarbonate level lower than 16 mEq/L
❖ Moderate to high ketone levels in urine or serum
Clinical Manifestations DKA
❖ Priority is correcting dehydration, electrolyte loss, and acidosis before correcting hyperglycemia. (Start IV fluid FIRST/Dehydration is priority)
❖ Establish IV access; begin fluid resuscitation
❖ NaCl, 0.45% or 0.9%
❖ Add 5% to 10% dextrose when blood glucose level approaches 250 - 300 mg/dL*
❖ Potassium replacement as needed (Due to insulin bring potassium levels down)
❖ *Continuous REGULAR insulin drip, (such as 5 unit/hr). (Regular is only insulin approved for IV administration.
❖ Frequent blood glucose level checks
DKA Management
❖ Most often seen in type 2 diabetics, especially the elderly
➢ typically associated with undiagnosed type 2, presence of illness
❖ Slow onset as compared to DKA
❖ Hyperglycemia - elevated glucose >600
❖ Hyperosmolality- elevated serum osmolality >320 (decreased fluid in blood/More glucose)
Hyperglycemic Hyperosmolaric Syndrome
❖ Hypotension
❖ Profound dehydration
❖ Tachycardia
❖ Neurological disturbances
❖ Abnormal Lab
❖ No ketosis (ABG would show ZERO Metabolic Acidosis)
HHS Cinical manifestation:
❖ Similar to DKA
➢ Lower glucose
➢ Fluid replacement
➢ Monitor/correct electrolyte imbalance
❖ Treatment of underlying causes (infections, illnesses)
HHS management
❖ Fluid Overload (Due to administering Fluids)
❖ Hypokalemia (Due to administering insulin)
❖ Cerebral edema
HHS TREATMENT complication
❖ Education on Diabetes Management
❖ Frequent SBGM
❖ Sick Day Management
❖ Encourage Fluids
Health promotion / prevention of diabetic complications
Management of Hospitalized Diabetics: Pg. 1526-1530
❖ Special Considerations
➢ Surgical patient vs. non-surgical
➢ Assess/evaluate self-care management
➢ Educate
➢ Avoiding Hyper- and Hypo- glycemia
➢ Dietary Concerns
■ NPO (determine whether to administer insulin or not)
■ Clear Liquid (are they getting enough carbs/protein?)
■ Enteral and Parenteral Nutrition
❖ Hygiene (prone to infections)
❖ Stress
❖ Gerontological concerns
Management of hospitalized diabetes
