Week 8 - DKA (diabetic ketoacidosis) Flashcards
Promotes uptake of glucose by the cells.
insulin
Where is insulin produced?
Pancreas in the B cells of the islets of Langerhans
Differentiate between T1D and T2D.
T1D - autoimmune - T cells attack Beta cells - cannot produce insulin in a significant amount
T2D - insulin is not as effective
An acute metabolic complication of diabetes occurring when fats are metabolized in the absence of insulin.
DKA
DKA is more likely in which DM subtype? Why?
T1D
this is because there is little to no insulin
DKA in children
- common emergency associated with ___
- leading cause of death in children with ______
- half of DKA deaths are due to _______; and the remainder are accounted for by _______ _________
T1D (bis)
cerebral edema
metabolic irregularities
Draw the pathophysiology pathway of DKA in children.
(refer to notes/readings)
Insulin deficiency leads to:
1) Counter regulatory hormone production (e.g. glucagon, GH, epinephrine, etc.) –> ketone and glucose production –> ketoacidosis–> (cycle) vomiting and increased resp rate –> dehydration –> reduction of urine output –> accumulation of glucose and ketones –> cycle
2) Hyperglycemia –> glycosuria –> osmotic diuresis –> dehydration (cycle)
What are the common presenting symptoms of DKA?
Rapid, deep sighing respiration (Kussmaul respiration)
NV, and anorexia
Abdo pain
Reduction of urine output
Signs of dehydration (weight loss, reduced skin turgor, reduced cap refill)
tachycardia
possible reduction in blood pressure (late)
Reduction of LOC
What are early signs of DKA?
Polyuria and polydispsia, increased respiratory rate and depth
Why do DKA patients vomit?
Try to get rid of acid, by vomiting HCL, to reduce the acidity caused by beta-hydroxybutyrate and aceto-acetate (ketone bodies)
What are the top 5 causes of DKA?
1 - unmanaged BG 2 - Infections 3 - Eating disorders 4 - Physical trauma 5 - Insulin pump failure/insulin omission
Describe primary prevention of DKA.
Raising awareness of early signs and symptoms
Describe secondary prevention of DKA
Comprehensive and ongoing education
What IV fluid is used for DKA?
What electrolyte needs to be replaced?
NS
K+
Why are we giving insulin to DKA patients?
The issue is due to a lack of insulin, it reduces glucose in the blood and also helps with the potassium shift into cells
When managing DKA, at what frequency are neuro exams completed? Why?
q1h
monitor for development of cerebral edema
What are warning signs of cerebral edema?
Headache return of vomiting behavioural changes reduced LOC elevation in BP and fall in pulse rate Decreased oxygen sats
What is the treatment for hyperkalemia?
fluid replacement and insulin therapy
sodium bicarbonate
What is the purpose of obtaining height and weight in DKA management?
Tx is based on BSA
Desribe how the vitals may change in DKA
breathing - rate and depth increased
BP - may drop
Oxygen sats - may drop
Capillary refill - slower
What are some diagnostics completed for DKA?
BW, ABGs, ECG, urinalysis
What do we look for in the urinalysis for DKA?
Nitrites, glucose and ketones
What are the key nursing interventions for DKA?
Fluids- NS Insulin therapy IVs - at least two BG - q1h Venous blood draws - q2h (bloodwork anion gap) ECG ins and outs Neuro and vitals q1h
What is the anion gap?
Sum of cations and anions
if the anion gap is closing, better results
Why are patients made NPO when they come in with DKA?
we don;t want their BG to rise
For DKA, describe how the finger prick glucose test will be.
the urine dipstick?
Finger prick - glucose will be high
Urine dipstick - sugars, ketones, nitrites
What are the reference ranges for sodium, potassium, chloride, glucose and urea?
Na+ - 134-143 K+ - 3.3-4.6 Cl- - 96-110 Glucose - 4-7 Urea - 1.8-6
What is the purpose of checking urea?
To evaluate liver function - glucose, ketones and potassium are hard on the kidneys
(would also check CR for adults)
What is the normal length of the QRS complex?
0.12-0.20
DKA patients are dehydrated, why don;t we just given them bolus by IV?
Can lead to cerebral edema, fluid overload, mess with lytes and is hard on the strained kidneys
Describe the switching of IV fluids.
Once the anion gap closes, switch to D5/45, then potassium chloride
What would be the rate of NS for DKA?
200
Go online and practice uncompensated, compensated, etc. things.
owo
Describe fluid resuscitation in DKA.
Isotonic NS at 10-20mg/kg over 1-2hrs then assess
Describe insulin therapy in DKA
0.1 unit/kg/hour 1-2 hours after IV rehydration started
Why do we start insulin therapy 1-2 hours after fluid rehydration?
Any earlier has been associated with cerebral edema
Why do patients need to rotate the sites they use for insulin admin?
Might cause scarring in the same site and thus reduced absorption
