DIABETIC KETOACIDOSIS (DKA)

Definition:
 Is an acute, major life-threatening complication of diabetes mellitus that mainly occurs in patients with type I Diabetes.
 Characterized by hyperglycemia, ketoacidosis and ketonuria

Etiology:
 Type I Diabetes
 Predisposing Factors: UTI, pneumonia, heart attack, physical or emotional trauma
 Precipitating Factors: Problems with Insulin therapy, alcohol or drug abuse, medications (corticosteroids and some diuretics)

Symptomatology:
 Hyperglycemia
 Ketoacidosis
 Ketonuria
 Excessive thirst
 Abdominal pain
 Nausea and vomiting
 Dehydration
 Altered mental status
 Metabolic acidosis (kussmaul’s respirations)
 Fruity scented breath
 Shortness of breath

Anatomy and Physiology: Endocrine Pancreas

 The pancreas is both an exocrine and an endocrine gland.
o Exocrine – secretes digestive enzymes
o Endocrine – secretes hormones glucagon, insulin, somatostatin and pancreatic polypeptides
 Cells and Secretions in the Pancreatic Islets (Islet of Langerhans’s)
o Alpha cells – produces glucagon. Low blood sugar stimulates the release of glucagon (Elevates blood sugar).
o Beta cells – produces insulin. High blood sugar stimulates the release of insulin (Lowers blood sugar).
o Delta cells – produces somatostatin, inhibiting the release of both insulin and glucagon.
o PP cells – secretes polypeptide hormones.
 Glucose is the key source of energy for the human body. Supply of this vital nutrient is carried through the bloodstream to many of the body’s cells.
 The brain can only utilize two forms of energy: Glucose and Ketones
 Insulin acts as a key that allows glucose to enter the cell.

Diagnosis:
 Blood sugar levels – usually exceeds 250mg/dL
 Arterial Blood Gas – metabolic acidosis, low bicarbonate and low pH
 Blood Urea Nitrogen (BUN) – frequently increase
 Blood electrolyte tests – K levels are high, Na is low, Cl and Ph are low
 CBC – increased WBC count
 Serum Ketones – Acetest and Ketostix
 Urinalysis – high glucose and ketone levels in urine
 Chest X-ray
 ECG – T wave changes

Treatment:
 Insulin Therapy – to regulate blood glucose levels and suppress ketone bodies
 Intravenous therapy – to correct dehydration and replace salts loss from urine
 Bicarbonate therapy
 Oxygen Therapy

Nursing Diagnoses with Interventions:

 Unstable blood Glucose Levels related to lack of diabetes management
o Monitor blood glucose levels q1 hour as indicated
o Monitor vital signs accordingly for hypo/hypertension, tachycardia and respiration changes
 Fluid Volume Deficit related to hyperosmolar urinary losses
o Monitor intake and output q1 hour as indicated
o Increase oral fluid intake and regulate IVFs as ordered
 Ineffective Breathing Pattern related to increased blood pH
o Monitor ECG tracings and Arterial blood gases
o Administer supplemental oxygen via nasal cannula
 Altered Mental Status related to impaired metabolic process
o Monitor neurovital signs q1 hour as indicated
o Provide safety by keeping side rails up
 Fatigue related to decreased metabolic energy production
o Advise patient to complete bed rest without bathroom privileges as order
o Keep things close to patient’s reach and provide call bells