Diabetic ketoacidosis

Diabetic ketoacidosis

1. Definition

   • Diabetic Ketoacidosis (DKA) is an acute and potentially fatal complication of diabetes typically characterized by hyperglycaemia, ketone body formation and metabolic acidosis. (Gosmanov et al, 2014

2. Etiology

   • dehydration owing to illness with vomiting or diarrhea
   • insulin not taken as prescribed, or omitted
   • infection
   • inadequate treatment of existing diabetic mellitus
   • change in diet, insulin or exercise regimen
   • Undiagnosed diabetic mellitus

3. Pathophysiology

   • It is caused by a relative or absolute deficiency of insulin that stimulates lipolysis resulting in the productionof acetyl coA from fattyacid when combined with increased levels of stress. the lack of insulin in DKA results in decreased glucose utilization and increased gluconeogenesis. This acetyl coA acts as the substracte for hepatic sythesis of ketone bodies (acetoacetate, beta hydroxybuthrate and acetone.

4. Clinical manifestation

   • Signs : Polyuria & Polydipsia leading to dehydration manifested by poor skin turgor, dry mucous membranes, tachycardia & orthostatic hypotension
   • Symptoms: Lethargy & weakness, dry & loose skin, sunken eye sockets and vomiting. Abdominal pain is occasionally seen. Kussmaul's respirations and acetone- a sweet fruity odour on the breath.
   • lab findings; Blood glucose level > 14mmol/L, arterial blood pH < 7.35, serum bicarbonate level < 15 mmol/L and ketones in the blood & urine.

5. Collaborative care

   • Admnistration of IV fluids
   • Assessment of blood and urine
   • Assessment of cardiovascular and respiratory status
   • Electrolyte replacement
   • Assessment of blood glucose levels
   • central venous pressure monitoing (if indicated
   • ECG monitoring
   • Assessment of mental status
   • Recording of intake and output
   • IV administration of rapid or short-acting insulin

6. Nusing intervnetion