What is DKA?

Diabetic ketoacidosis (DKA) is a life-

threatening problem that affects people
with diabetes. It occurs when the body
starts breaking down fat as a fuel,
thereby producing ketones, which
causes the blood to become acidic.
 Normal

Gluc
ose

Glu
cose

Glu
cose

Glu
cose
Insu
Insu
lin lin
 DKA

↑ blood sugar
Glu
cose

Glu
cose

Glu
cose

Glu
cose

=Energy
 DKA

Glu
cose

Glu
cose

Glu
cose

Glu
Glu cose
cose
Glu
cose
 DKA
Glu
cose
Ketones
Ketones
Glu
cose Ketones

Glu
cose

Glu Energy
cose
Energy Energy

Glu
cose

Glu
cose
3 significant occurrence in DKA

Ketones
↑ blood sugar Ketones

Ketones

Cellular Starvation Hyperglycemia Presence of Ketones

in the bloodstream as
a by-product of
breaking down fats as
alternative source of
energy
 Clinical Manifestations
 Weakness
 Polyphagia
Ketones
 Excessive Hunger
↑ blood  Polyuria
sugar  Compensation to get rid of excessive glucose
 Excessive urination
 Urinate potassium and other electrolytes
 Dehydration
 Dry mucus membrane
 Decreased skin turgor
 Polydipsia
 Frequent drinking due to extreme thirst
 Metabolic Acidosis
 Ph <7.35
 Kussmauls Respiration
 Rapid respiration
 Fruity breath smell/ Acetone-smell breath
 Respiratory system trying to compensate to acidosis
 5 hallmark signs:
1. Hyperglycemia
2. Ketosis
3. Acidosis
4. Dehydration
5. Electrolyte Imbalance
 Nursing Management
1. Education
2. Pharmacological
 Education
Teaching aspects:
Prevention and Warning Signs Awareness
1. Monitor blood sugar and ketones in
urine if sick
2. Notify doctor: cannot drink water, BS
>300mg/dl, (+) urine ketones, fruity
breath and other symptoms of DKA
Nursing Considerations

S
• Stress
Monitor blood • Sickness
sugar closely!! • Sepsis/ Infection
• Surgery
Pharmacological
as per doctor’s order

1. Hydration
2. Insulin Administration
3. Electrolyte Correction
Pharmacological
1. Hydration
Establish IV and hydrate with fluids
Initially with PNSS (0.9 NS)
Once sugar level is between 200-300mg/dl,
switch to fluids with dextrose (D5 0.45)
-prevent rapid drop in sugar which may lead to
cerebral edema (water will move from blood to CSF)
Pharmacological
2. Insulin Administration
Regular Insulin is the only
Insulin Drip insulin given thru IV

Monitor blood sugar level

Monitor potassium level
–insulin puts K back to the cell, therefore
causing LOW blood potassium
 Pharmacological
3. Electrolyte Correction
Monitor labs
Correct potassium if low
KCL drip: watch out for phlebitis
Nursing Considerations

Peaks = Plates
Nursing Considerations
Inspect skin areas that will be used for
injection; note any areas that are
bruised, thickened, or scarred, which
could interfere with insulin absorption
and alter anticipated response to insulin
therapy.
Obtain blood glucose levels as

Assess ordered to monitor response to insulin.

Monitor patient’s food intake, exercise
and activities which can alter serum
glucose levels to ensure therapeutic effect
and avoid hypoglycemia.
Nursing Considerations

S
• Stress
Strict • Sickness
Monitoring
• Sepsis/ Infection
• Surgery
Nursing Considerations
Hot and dry,
sugar is high
Cold and clammy,
needs some candy
Nursing Considerations
Always verify the name of the insulin
being given because each insulin has a
different peak and duration, and the
names can be confused.
 Gently rotate the vial containing
the agent by rolling the vial
gently between hands and avoid
vigorous shaking to ensure
uniform suspension of insulin
Nursing Considerations
Rotate injection sites to avoid damage to
muscles and to prevent subcutaneous
atrophy or lipodystrophy.

Provide patient education about drug

effects and warning signs to report to
enhance patient knowledge and to
promote compliance.
Nursing Considerations
Store insulin in a cool place away from
direct sunlight. Refrigeration is preferred.
Do not freeze insulin.
Insulin prefilled in plastic syringes is stable
for 1 week refrigerated; this is a safe way of
ensuring proper dosage for patients with
limited vision or who have problems with
drawing up insulin.