Assessment for Diabetic Ketoacidosis 

level decreases that gives off a pale

skin color.  
6. BP 90/60 
1. Vague Abdominal Pain  o Nerve sensors in the arteries that
o Caused by increased acid production monitor blood pressure may not work
as evidenced by metabolic acidosis  effectively if the patient has excess
o Cause by increase pH→ increased glucose in the blood. 
ketones → increase acid (Lactic) as o In addition, since the patient was
evidenced by metabolic acidosis  diagnosed with dehydration, it can be a
2. Dizziness & Weakness  factor since the body loses more water
o Increased levels of glucose in the blood than it takes in. 
cause the kidneys to remove more 7. Vomited once 
glucose during filtration.  o As ketones accumulate in the blood,
o As a result, more water will be lost more ketones are excreted in the urine,
during urination which can cause the taking sodium and potassium salts
patient to be dehydrated.  together. 
3. Unquenchable Thirst (Polydipsia) o Over time, the body's sodium and
o Excess glucose build up in the blood potassium salts can become depleted,
makes the kidneys work extra hard in causing nausea and vomiting. 
order to filter and absorb the excess o Nausea & Vomiting as the body tries to
glucose. Excess glucose then excreted compensate with the increase of pH in
into the urine, pulling fluids from tissues the body which is 7.25 
causing dehydration.  8. Generalized Muscle Weakness & Hypotonia 
o This generally leaves a thirsty feeling. o Impaired insulin secretion can lead to
Drinking more water to quench thirst poor uptake of glucose in the muscles. 
causes more urination.  o The lack of glucose in the muscle can
4. Frequent Urination (Polyuria) ( Stimulates lead to muscle cell atrophy causing
hypothalamus since dehydrated)  decrease in muscle mass and tone.  
o It occurs when there are excessive o Chronic elevation of glucose can cause
levels of glucose in the bloodstream. nerve damage. 
As a result, the kidneys are forced to o This can lead to a complication of
work overtime in order to rid excess diabetes called diabetic neuropathy
glucose in the blood.  which involves the damaging of nerve
o By the time the kidneys cannot cells which may manifest as loss of
compensate for the excessive amount sensation and poor or absent reflexes
of glucose, it will be excreted into the as well as loss of muscle tone.
urine.  9. HR 138 bpm (Normal 60-100bpm) 
o Moreover, glucose attracts water that is o Caused by dehydration from strenuous
also attributed to this osmotic diuresis activity putting strain or pressure on the
which is characterized by excreting heart. 
large volumes of urine.  o Brought by a decrease in blood volume
5. Weight Loss (5kg) (Weight : 90kg, Height 5’7)  resulting in the heart compensates by
o The body needs fluid to function and beating faster or increased heart rate. 
when the body loses fluid by sweating o Furthermore, when the blood becomes
or frequent urination the muscle mass acidic, the acidity alters cardiac ion
is more likely to reduce as well.  channel function and can predispose
o When the body can’t get enough the heart to develop an irregular
glucose from the blood, they will burn heartbeat. 
fats to use it as energy that leads to 10. Tachypnea 38 (Normal 16-20cpm) 
build up of ketones in the body o Tachypnea and an increase in depth of
(Ketosis) Pale, dehydrated, dry mucous breath are characteristic of Kussmaul's
membrane & Poor skin turgor  breathing, a sign of Diabetic
o Caused by a rapid fluid loss of the body Ketoacidosis in response to metabolic
as evidenced by vomiting, acidosis. (Due to increased carbon
unquenchable thirst and frequent dioxide) 
urination leads to dehydration.   o Oxygen administration 
o Since dehydration occurs, the body o Large ketones in the urine 
receives less nutrients and oxygen BUN 
  To monitor kidney functioning 
 Elevated BUN will tell you that the kidneys are
not able to excrete excess UREA (Due also to
excess fluid loss)  DIABETIC KETOACIDOSIS 
 Urea is a by-product of ammonia metabolism
in which when the liver releases glucagon  1. Fluid volume deficit “Dehydration” 
 Diet  2. Hyperglycemia 
3. Decreased Cardiac Output 
Na (138)  4. Risk for AKI
 Excessive water loss, so sodium is retained
inside = Polyuria  DEHYDRATION
 Fluid replacement (1L/day) or MORE THAN  Parang drunk,
 IV : d5W, 0.9 NaCl (isotonic) —> indicated if  warm / flushed skin
there is plenty of sodium and ↓ fluid = 0.9 NaCl  Dizziness and weakness
since fluid replacement lang since sodium is  Fatigue
high   shock 
 to 0.4 NaCl (hypotonic) —> more water which  (low blood volume, tachycardia,
dilutes the sodium  tachypnea, hypotension, cold clammy
skin) 
Potassium (6.5)   Makes you urinate frequently → dehydrated
 Kayexelate 
 Sodium Chloride Chloride (90)  ABG 
 In DKA, bicarbonate is replaced by β- As the pH goes so goes my patient 
hydroxybutyric acid and acetoacetic acid, so Acidosis - low pH → low activity ng patient 
that the sum of bicarbonate and chloride  Pt may show: weakness, dizziness, feeling
concentrations is reduced  tired easily fatigue, nausea and vomiting
muscular hypotonia high potassium, and fast
Dehydration  HR 
 Treat dehydration with rapid IV infusions of Alkalosis - high pH → increase  activity ng pt
0.9% or 0.45% NS as prescribed; dextrose is  Pt may show: increase RR, anxious, low
added to IV fluids when the blood glucose level potassium, and low HR
reaches 250 to 300 mg/dL (13.9 to 16.7
mmol/L).  KETOSIS - Kussmaul's 
 Too rapid administration of IV fluids; use of the ACIDOSIS- Metabolic Acidosis 
incorrect types of IV fluids, particularly
hypotonic solutions; and correcting the blood INSULIN types
glucose level too rapidly can lead to cerebral Regular 
edema.   intermediate 
 commonly used
Creatinine   Onset 1 hr 
 Monitor if there is renal impairment  peak is 2 hours
 duration 4hrs
Reabsorption   ito lang pwede insulin drip
 Movement of water & solutes from the nephron  To prepare: 1 unit of insulin = 50  cc of plain
tubule back into circulation  NSS
Secretion 
 Movement of solutes & water from the NPH 
circulation into the nephron tubule   intermediate 
 Commonly used
 onset 6 hours 
For CBG: Alcohol swab, lancet, CBG strip, CBG  peak is 8-10 hour 
machine, cotton balls   duration is 12 hours
Dehydrated — Drunk + Shock = (Dizziness,
weakness, vomiting, Hypotension, tachycardia, Glargine (Long acting)
tachypnea)   commonly used
 No onset and peak duration 12-24 hours

Rapid-acting (Short-acting)
  Example: Lispro 
 30 mins onset

MANAGEMENT
Walang sugar → bigyan ng sugar vv 

For dehydration
 give plain NSS first later na yung for sugar 
 Give plain NSS kasi may chance na mag
shock so prevent muna shock 

Potassium:
 To give potassium dilute to plain NSS
 Use infusion pump para accurate
 Check vs esp: HR kasi mag increase
 Check IV site for skin integrity, bruising 
Hypoglycemia
 Check glucose level
 IV D5050 ayan yung para sa unstable tas yun

Insulin Drip 
 1:1 = 1mL : 1 unit = 50 cc 
 to address glucose & potassium 
 When giving insulin check for potassium &
glucose ➡ Hourly CBG 
For vomiting: 
 Give metoclopramide 
 Check level of consciousness
 Risk for fall → check for safety

For metabolic acidosis:

 Treat high blood sugar first give insulin

Ex:
Stock dose 40meqs K
Diluent: 100cc Desired dose/stock dose x diluent