Fluid And Electrolyte Imbalance - Ketoacidosis

Question 1

DKA results from

Answer 1

Combination of insulin deficiency and an increase in counterregulatory hormone release

Question 2

Most common precipitating factor of DKA

Answer 2

Infection

Question 3

Mortality is highest for those who also have

Answer 3

Infection, stroke, MI, vascular thrombosis, intestinal obstruction, or pneumonia

Question 4

Hyperglycemia leads to

Answer 4

Osmotic diuresis with dehydration and electrolyte loss

Question 5

Symptoms of DKA

Answer 5

Polyuria,
Polydipsia,
Polyphagia, 
Weight loss, 
Vomiting,
Abdominal pain, 
Dehydration, 
Altered mental status, 
Shock, 
Coma

Question 6

Mental status

Answer 6

Total alertness to profound coma

Question 7

As keytone levels rise,

Answer 7

The buffering capacity of the body is exceeded, blood pH decreases, and acidosis occurs

Question 8

Kussmaul respirations cause

Answer 8

Respiratory alkalosis in attempt to correct metabolic acidosis by exhaling CO2; rapid and deep respiratory pattern

Question 9

DKA onset

Answer 9

Sudden

Question 10

DKA precipitating factors

Answer 10

Infection, other stressors, and inadequate insulin dose

Question 11

DKA manifestations

Answer 11

Ketosis (fruity breath, nausea, abdominal pain), dehydration or electrolyte loss (polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma)

Question 12

Serum glucose in DKA

Answer 12

> 300 mg/dL

Question 13

Osmolarity in DKA

Answer 13

Variable

Question 14

Serum keytones in DKA

Answer 14

Positive at 1:2 dilutions

Question 15

Serum pH in DKA

Question 16

Serum HCO3 in DKA

Question 17

Serum Na in DKA

Answer 17

Low, normal, or high

Question 18

BUN in DKA

Answer 18

> 30 mg/dL (elevated d/t dehydration)

Question 19

Creatinine in DKA

Answer 19

> 1.5 mg/dL (elevated d/t dehydration)

Question 20

Urine keytones in DKA

Answer 20

Positive

Question 21

Priority assessment for DKA

Answer 21

Airway, LOC, hydration status, electrolytes, and blood glucose level

Question 22

Monitor every 15 minutes until stable

Answer 22

BP, pulse, respirations

Question 23

Monitor hourly

Answer 23

Urine output, temp, mental status

Question 24

Every 30 minutes

Answer 24

Central venous pressure if central venous catheter is present

Question 25

Kidneys are less able to respond to

Answer 25

Changes in pH or fluid and electrolyte balance, to concentrate urine, or to regulate blood osmolarity

Question 26

First outcome of fluid therapy

Answer 26

Restore volume and maintain perfusion to the brain, heart, and kidneys; use rate of 15-20 mL/kg during the first hour

Question 27

Second outcome of fluid therapy

Answer 27

Replacing the total body fluid losses; typically hypotonic fluid infused at 4-14 mL/kg/hr after initial fluid bolus

Question 28

Prevent hypoglycemia and cerebral edema during treatment

Answer 28

When blood glucose levels = 250mg/dL, give 5% dextrose in 0.45% saline

Question 29

First 24 hrs of treatment

Answer 29

Pt needs fluid to replace deficit and ongoing loss (maybe 6-10 L); assess cardiac, kidney, and mental status to avoid fluid overload; watch for signs of congestive heart failure and pulmonary edema

Question 30

Assess fluid status

Answer 30

Monitor BP and I and O

Question 31

Treatment of choice to lower blood glucose by 50-75 mg/dL/hr

Answer 31

Regular insulin by IV infusion; IV bolus 0.1 unit/kg followed by 0.1 unit/kg/hr

Question 32

IV insulin

Answer 32

4-minute half-life

Question 33

Subcutaneous insulin

Answer 33

Started when pt can take oral fluids and ketones has stopped; delayed onset of action and prolonged half-life when compared to IV insulin

Question 34

Resolution of DKA

Answer 34

Blood glucose 18 mEq/L; venous pH >7.3; calculated ion gap

Question 35

DKA is characterized by

Answer 35

Uncontrolled hyperglycemia, metabolic acidosis, and increased production of keystones

Question 36

No Kidding Insulin Always Helps

Answer 36

``` N - NS; K - potassium; I - insulin; A - abx; H - HCO3 ```

Question 37

Which electrolyte is most effected by hyperglycemia?

Answer 37

Potassium

Question 38

What type of insulin is used in the emergency treatment of DKA?

Answer 38

Regular insulin via IV

Question 39

Pt admitted with BG of 900 and 2 hrs after treatment initiation with IV insulin, it is 400. What complication is pt at risk for?

Answer 39

Hypoglycemia: BS should only come down 50-75/hour

Question 40

Hypertonic

Answer 40

Pulls fluid out of the cells; cells shrink; will administer for DKA after BS reaches >250 mg/dL; D5 0.45%NS

Question 41

Hypotonic

Answer 41

Cells swell; pulls fluid into cells; D5W, 0.45%NS

Question 42

Isotonic

Answer 42

"I'm so perfect"; keeps cells just the way they are; use for maintenance fluid; 0.9%NS, LR

Question 43

Regulate glucose on a sick day

Answer 43

FSBS Q4h; test urine for ketones if FSBS>240; continue insulin; 8-12 oz fluid/hr; eat at regular times; rest; treat symptoms; BRAT diet; ondansetron PRN; notify provider for danger signs

Question 44

Danger signs on sick day

Answer 44

Persistent N/V; moderate or large keytones; increased FSBS after 2 doses of insulin; elevated temp