DM Complications- DKA

Question 1

DKA happens with what type of DM

Answer 1

Almost Always type one diabetes

Question 2

DKA is caused by

Answer 2

an absolute absence of insulin

Question 3

DKA is characterized by

Answer 3

hyperglycemia (cause theres no insulin)
ketosis (no insulin-body goes after fat)
Acidosis (cause of the breakdown of keynotes)
Dehydration

Question 4

Precipitating factors of DKA

Answer 4

infection
illness
inadequate insulin dosage
undiagnosed type 1 diabetes
poor self-management
neglect

Question 5

Clinical manifestation of DKA….that darn dehydration…. s/s of dehydration include

Answer 5

poor skin turgor
dry mucus membranes
tachycardia
orthostatic hypotension

as patient becomes more dehydrated skin dry and loose, eyes soft and sunken

Question 6

S/S of DKA

Answer 6

leathery and weakness (early s/s)
dehydration
abdominal px, anorexia, N/V
Kussmaul respirations
Sweet, fruity breath
bld glucose level of 250 mg/dl or higher
bld pH lower than 7.30 
Serum bicarbonate level lower than 16 mEq/L
Positive ketone levels in urine or serum

Question 7

DKA patients are usually hospitalized for

Answer 7

severe fluid and electrolyte imbalance, fever, N/V, diarrhea, altered mental state

Question 8

What we need to do for our DKA patients

Answer 8

Ensure patient airway, administer O2
Establish large bore IV access (helps massive cellular dehydration)
Begin fluid resuscitation (NS used mostly)
Blood Sugar management (insulin drip-give regular insulin IV. CHECK BG q hour)
Potassium Balance (frequent monitoring, replace is below 3.5)
Acidosis Management (start sodium bicarb if pH is below 7.2 and stop it when its back to 7.2)

Question 9

The DKA patient should be started switched to _________ as soon as the blood glucose is down to ____

Answer 9

1) DW5

2) 250

Question 10

you should replace the potassium of the DKA patient when it is below

Answer 10

3.5

Question 11

You should start ________ if the pH of your DKA patient is below _____ and stop it when the pH returns to ____

Answer 11

1) Sodium bicarb
2) 7.2
3) 7.2

Question 12

For DKA patient always start with _______ and the initial goal of treatment is to ____________

Answer 12

1) Airway - and administer the O2

2) establish IV access and begin fluid and electrolyte replacement

Question 13

your have to ensure adequate kidney function which is ____of urine, before administering _______

Answer 13

30 ml of urine before administering potassium

Question 14

Whats a normal anion gap and how is It calculated

Answer 14

anion gap 7-9 mEq/L

subtract the sum of chord and bicarb concentration from the sodium concentration

Question 15

What are the sick day rules..

Answer 15

• Check BG q4 hr
• Notify health care provider of illness
• Test urine for ketones
• Continue with diabetic medications
• if unable to eat solids then drink carbohydrate content of the meal
• call provider if N/V, moderate to large ketones, fever