Week 8 - DKA (diabetic ketoacidosis)

Question 1

Promotes uptake of glucose by the cells.

Answer 1

insulin

Question 2

Where is insulin produced?

Answer 2

Pancreas in the B cells of the islets of Langerhans

Question 3

Differentiate between T1D and T2D.

Answer 3

T1D - autoimmune - T cells attack Beta cells - cannot produce insulin in a significant amount

T2D - insulin is not as effective

Question 4

An acute metabolic complication of diabetes occurring when fats are metabolized in the absence of insulin.

Answer 4

DKA

Question 5

DKA is more likely in which DM subtype? Why?

Answer 5

T1D

this is because there is little to no insulin

Question 6

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 _______ _________

Answer 6

T1D (bis)
cerebral edema
metabolic irregularities

Question 7

Draw the pathophysiology pathway of DKA in children.

Answer 7

(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)

Question 8

What are the common presenting symptoms of DKA?

Answer 8

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

Question 9

What are early signs of DKA?

Answer 9

Polyuria and polydispsia, increased respiratory rate and depth

Question 10

Why do DKA patients vomit?

Answer 10

Try to get rid of acid, by vomiting HCL, to reduce the acidity caused by beta-hydroxybutyrate and aceto-acetate (ketone bodies)

Question 11

What are the top 5 causes of DKA?

Answer 11

1 - unmanaged BG
2 - Infections
3 - Eating disorders
4 - Physical trauma
5 - Insulin pump failure/insulin omission

Question 12

Describe primary prevention of DKA.

Answer 12

Raising awareness of early signs and symptoms

Question 13

Describe secondary prevention of DKA

Answer 13

Comprehensive and ongoing education

Question 14

What IV fluid is used for DKA?

What electrolyte needs to be replaced?

Answer 14

NS

K+

Question 15

Why are we giving insulin to DKA patients?

Answer 15

The issue is due to a lack of insulin, it reduces glucose in the blood and also helps with the potassium shift into cells

Question 16

When managing DKA, at what frequency are neuro exams completed? Why?

Answer 16

q1h

monitor for development of cerebral edema

Question 17

What are warning signs of cerebral edema?

Answer 17

Headache
return of vomiting
behavioural changes
reduced LOC
elevation in BP and fall in pulse rate
Decreased oxygen sats

Question 18

What is the treatment for hyperkalemia?

Answer 18

fluid replacement and insulin therapy

sodium bicarbonate

Question 19

What is the purpose of obtaining height and weight in DKA management?

Answer 19

Tx is based on BSA

Question 20

Desribe how the vitals may change in DKA

Answer 20

breathing - rate and depth increased
BP - may drop
Oxygen sats - may drop
Capillary refill - slower

Question 21

What are some diagnostics completed for DKA?

Answer 21

BW, ABGs, ECG, urinalysis

Question 22

What do we look for in the urinalysis for DKA?

Answer 22

Nitrites, glucose and ketones

Question 23

What are the key nursing interventions for DKA?

Answer 23

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

Question 24

What is the anion gap?

Answer 24

Sum of cations and anions

if the anion gap is closing, better results

Question 25

Why are patients made NPO when they come in with DKA?

Answer 25

we don;t want their BG to rise

Question 26

For DKA, describe how the finger prick glucose test will be.

the urine dipstick?

Answer 26

Finger prick - glucose will be high

Urine dipstick - sugars, ketones, nitrites

Question 27

What are the reference ranges for sodium, potassium, chloride, glucose and urea?

Answer 27

Na+ - 134-143
K+ - 3.3-4.6
Cl- - 96-110
Glucose - 4-7
Urea - 1.8-6

Question 28

What is the purpose of checking urea?

Answer 28

To evaluate liver function - glucose, ketones and potassium are hard on the kidneys
(would also check CR for adults)

Question 29

What is the normal length of the QRS complex?

Answer 29

0.12-0.20

Question 30

DKA patients are dehydrated, why don;t we just given them bolus by IV?

Answer 30

Can lead to cerebral edema, fluid overload, mess with lytes and is hard on the strained kidneys

Question 31

Describe the switching of IV fluids.

Answer 31

Once the anion gap closes, switch to D5/45, then potassium chloride

Question 32

What would be the rate of NS for DKA?

Answer 32

200

Question 33

Go online and practice uncompensated, compensated, etc. things.

Answer 33

owo

Question 34

Describe fluid resuscitation in DKA.

Answer 34

Isotonic NS at 10-20mg/kg over 1-2hrs then assess

Question 35

Describe insulin therapy in DKA

Answer 35

0.1 unit/kg/hour 1-2 hours after IV rehydration started

Question 36

Why do we start insulin therapy 1-2 hours after fluid rehydration?

Answer 36

Any earlier has been associated with cerebral edema

Question 37

Why do patients need to rotate the sites they use for insulin admin?

Answer 37

Might cause scarring in the same site and thus reduced absorption