Diabetic Ketoacidosis

Diabetic Ketoacidosis

1. Classical Triad in DKA

   • Hyperglycemia
   • Ketosis
   • Acidosis

2. 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)

3. 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

4. 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

5. 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

6. 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

7. Complications

   • Shock
   • Vascular thrombosis
   • Pulmonary Edema
   • Cerebral edema
   • Hypovolemia
   • Renal Failure
   • Dehydration

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