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Diabetic Ketoacidosis Overview

Diabetic ketoacidosis is caused by a lack of insulin leading to the breakdown of fatty acids which produces ketones and metabolic acidosis. People with type 1 diabetes who do not take insulin are at highest risk. Signs and symptoms include fruity breath, rapid deep breathing, weakness and abdominal pain. Treatment involves rehydration with IV fluids, potassium replacement, and IV insulin to reduce blood glucose and ketone levels until the patient can eat and acidosis is resolved. Close monitoring of vital signs and labs is important to manage this potentially life-threatening complication of diabetes.

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633 views2 pages

Diabetic Ketoacidosis Overview

Diabetic ketoacidosis is caused by a lack of insulin leading to the breakdown of fatty acids which produces ketones and metabolic acidosis. People with type 1 diabetes who do not take insulin are at highest risk. Signs and symptoms include fruity breath, rapid deep breathing, weakness and abdominal pain. Treatment involves rehydration with IV fluids, potassium replacement, and IV insulin to reduce blood glucose and ketone levels until the patient can eat and acidosis is resolved. Close monitoring of vital signs and labs is important to manage this potentially life-threatening complication of diabetes.

Uploaded by

Janet
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Diabetic Ketoacidosis

Pathophysiology
NO insulin → can’t get glucose into cell→ breaks down fatty acids for energy → Ketones (acids) → metabolic
acidosis
Osmotic diuresis → dehydration
No insulin → ↑ liver glucose production → hyperglycemia (higher)

Risk Factors o Type 1 diabetes not taking insulin

Signs and Symptoms  Fruity breath,


(We treat signs and  Rapid, deep respirations (Kussmaul)
symptoms)  Weakness
 Abdominal pain
Cardinal signs:  Blurred vision
Fruity breath  Headache
Rapid, deep respirations  Polyuria
(Kussmaul)  Polydipsia
Weakness  Dehydration
Abdominal pain  Poor skin turgor
 Dry mucuous membranes
 Orthostatic hypotension
 Weakness
 lethargy

VITALS:
RR > 30
HR > 100
BP – low
Temp – 99 – 99.5

Electrolytes
High Potassium
Low sodium
Low magnesium
Low phosphorous
Low chloride

Treatment ▫ Rehydrate NS, ½ NS (hours in to avoid FVO), D5NS (250-300, bring down slowly
to prevent hypoglycemia and rebound DKA)
Serum sodium high but ▫ K+ replacement once voiding reestablished
TRUE HYPOKALEMIA – ▫ Must be supplemented even if serum K+ normal.
not in cells where ▫ IV Regular insulin 5u/hr until serum bicarb = 15-18 mEq/mL AND pt can eat
needed ▫ Monitor orthostatic hypotension
▫ Initiate fall risk/safety precautions
▫
Labs and Diagnostic Tests
Name of Test Expected Finding Normal Finding
pH <7.35 7.35 – 7.45
HCO3 < 22 22 - 26
UA ketones No ketones
UA High range
K+ >5 3.5 - 5
Glucose 300 - 800 mg/dL 70 - 100
BUN > 20 10 – 20
creatinine > 1.2 0.6 – 1.2
Nursing Goals

Nursing Management/Interventions
Assessments  First nursing action: Begin fluid replacement/ check electrolytes
 Place on ECG—careful cardiac monitoring necessary
 Frequent VS, lung assessment
 Monitor I&O to prevent FVO
 Correct acidosis
 Insulin therapy → helps stop fatty acid breakdown
 Insulin therapy continues until anion gap acidosis has fully resolved.
Interventions 

Complications to Avoid

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