Diabetic Ketoacidosis - Jessica and Misbah

Diabetic Ketoacidosis - Jessica and Misbah

1. Interventions

   • Adjust fluid volumes (Nyenwe & Kitabchi, 2016)
     • correcting electrolyte imbalance
       • restoring hyperosmolaity
     • Fluid replacement using IV solutions (Nyenwe & Kitabchi, 2016)
       • Normal Saline
       • Ringers Lactate
   • Increase tissue perfusion (Nyenwe & Kitabchi, 2016)
   • Restore blood glucose (Nyenwe & Kitabchi, 2016)
     • insulin therapy (Noble-Bell & Cox, 2014)
   • resolving ketosis (Nyenwe & Kitabchi, 2016)
   • Nursing Assessments
     • Monitor fluid balance: intake and output (Noble-Bell & Cox, 2014)
     • Monitor vital signs and level of consciousness hourly (Use Glascow scale) (Noble-Bell & Coz, 2014)
     • Monitor for signs of related to fluid overload, dehydration, electrolyte imbalance (Noble-Bell & Cox, 2014)
     • Capillary Blood Glucose and ketones every 1 hour during acute phase (Noble-Bell & Cox, 2014)
     • Monitor serum potassium levels (Noble-Bell & Cox, 2014)
     • Blood gases in monitoring for acidosis/alkalosis (Noble-Bell & Cox, 2014)

2. Etiology

   • Diabetes Type I / Diabetes Type II (Nyenwe & Kitabchi, 2016)
     • Insulin deficency, and increase glucose in the blood stream
     • Infection (Westerberg, 2013)
       • Pneumonia
       • Urinary Tract infection
       • Sepsis
     • Certain Medications (Wetserberg, 2013)
       • Antipsychotics (Wetserberg, 2013)
       • corticosteroids, glucagon, interferon, pentamidine, sympathomimetic agents, thiazide diuretics (Wetserberg, 2013)
       • Illicit drugs: cocaine, alcohol (Wetserberg, 2013)

3. Risk factors

   • Vomiting (Nyenwe & Kitabchi, 2016)
   • Fasting (Nyenwe & Kitabchi, 2016)
   • Pregnant (Nyenwe & Kitabchi, 2016)
   • poor adherence to insulin/ or insulin omission (Anzola, Gomez, & Umpierrez, 2016)
   • New diagnosis (Nyenwe & Kitabchi, 2016)
   • Previous DKA (Wolfsdorf et al., 2014)
   • poor management of hydration (Wolfsdorf et al., 2014)
   • Eating disorders (Wolfsdorf et al., 2014)
   • Lack of access to health care (Wolfsdorf et al., 2014)

4. Clinical Manifestations: Evolves over a short time period & can pogress quickly. (Nyenwe & Kitabchi, 2016)

   • Lab values
     • glucose > 250 mg/dl (Nyenwe & Kitabchi, 2016)
   • Metabolic Acidosis (Westerberg, 2013)
     • Kussmaul Respirations
     • Ph < 7.35 (Nyenwe & Kitabchi, 2016)
     • HCO3 <22mmol/ L (Nyenwe & Kitabchi, 2016)
   • Hyperglycemia (Westerberg, 2013)
     • Polydipsia
     • Polyphagia
     • Polyuria
     • Weightloss
     • Fatigue
   • Vomiting (Nyenwe & Kitabchi, 2016)
   • Abdominal Pain (Nyenwe & Kitabchi, 2016)
   • Dehydration (Westerberg, 2013)
     • Hypotension
     • Tachycardia
     • Poor skin turgor
     • Dry mucous membranes
     • Orthostatic hypotension
   • Decreased level of Consciousness (Anzola et al., 2016)
   • Ketosis: acetone scent (Sweet smell) (Nyenwe & Kitabchi, 2016)

5. Pathophysiology

   • Insulin deficiency (Westberg, 2013)
     • increase in counter regullatory hormones (Westberg, 2013)
       • glucagon
       • catechalomines
       • cortisol
       • growth hormones
     • Fats are broken down into ketones (Westberg, 2013)
       • Proteins are broken down (Westberg, 2013)
         • Glucose and ATP is created (Westberg, 2013)
           • Leads to hyperglycemia and osmotic diuresis (Westberg, 2013)
             • Dehydration
             • Hyperosmolaric state.
             • Metabolic acidosis

6. Complications

   • Hypoglycemia (Nyenwe & Kitabchi, 2016)
     • Due to insulin overtreatment (Nyenwe & Kitabchi, 2016)
   • Acute Renal failure (Westerberg, 2013)
   • Shock (Westerberg, 2013)
   • Cerebral Edema (Westerberg, 2013)
   • Hypokalemia (Nyenwe & Kitabchi, 2016)

7. Prevention

   • Health teaching (Anzola et al., 2016)
     • adherence to insulin therapy
     • controling blood glucose levels
     • how to adjust insulin when ill
     • maintaining adequate fluid intake
   • Addressing barriers (Anzola et al., 2016)
     • in access to health care, primary care
     • in communication with the health care provider, or social supports
     • in social supports such as family, friends school and it's affect on health

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