Zusammenfassung der Ressource
Diabetic Ketoacidosis
- Classical Triad in
DKA
- Hyperglycemia
- Ketosis
- Acidosis
- Etiology
- Type I Diabetes Mellitus
- Type II Diabetes Melitus with other Illness
- Insulin omission
- Infection
- Dehydration owing to illness with vomiting and
diarrhea
- Change in diet, insulin, or exercise regimen
- Intra-abdominal process (cholecystitis,
pancreatitis)
- Clinical
Manifestations
- Polyuria
- Polydipsia
- Polyphagia
- Dry mouth
- Abdominal pain
- Nausea and vomiting
- Level of Conscussioness : gradually increasing restless, confusion,
lethargy
- Flushed, dry skin
- Eyes appear sunken
- Fruity breath
- Kussmaul's respiration
- Pulse: rapid, weak
- Orthostatic
hypotension
- Oral or vaginal Candida albicans
- Dehydrations
- Fatigue
- Laboratory
Findings
- Serum
- Increased Blood Glucose level
(BC)>14mmol/mL
- Decreased Na
- Decreased HCO3
- Increased BUN
- Increased
creatinine
- Ketonemia
- Decreased PO4
- Increased osomolity
- Increased Potassium
- ABG
- Metabolic acidosis (arterial blood
pH below 7.35)
- Urine
- Glucosuria
- Ketonuria
- Nursing
Interventions
- Initial
- Ensue patent airway
- Administer oxygen as per physician's
order
- Establish IV access with large-bore
catheter
- Fluid resuscitation 0.9% NaCL solution: until BP satblized and urine output
30-60mL/hr
- Insulin therapy
- Initially load: 0.1U/kg/body weight (IV regular insulin
bolus)
- Maintenance: 0.1 unit/kg/hr as needed (regular insulin
drip)
- IV Potassium replacement: to correct hypokalmia
- IV Sodium bicarbonate if sever acidosis
(pH<7.0)
- Identify history of:diabetes, time of last food, time and amount of last insulin
infection
- Ongoing
Monitoring
- Vital
signs
- Level of consciousness Glasgow Coma Scale every 1-2h
- ECG
- Oxygen
saturation
- Urine
output
- Assess breath sounds for fluid
overload
- Monitor
Levels
- Glucose
- pH
- Electrolytes
- Bicarbonates
- Blood
Gases
- Patient Education
- Diabetic education
- Blood glucose
monitoring
- Identification of precipitating
factors
- Home monitoring of ketones
- Supplemental short-acting insulin regimens
- Easily digestible liquid diets when sick
- Guidelines for when patients should seek medical
attention
- Special education for patients on pump management
- Check Insulin device working properly
- Use Insulin per Prescriptions
Schedule
- Complications
- Shock
- Vascular thrombosis
- Pulmonary Edema
- Cerebral edema
- Hypovolemia
- Renal Failure
- Dehydration