DKA

Diabetic Ketoacidosis

DKA

• a complication from diabetes

• it’s sudden

• uncontrolled hyperglycemia

• imbalance of insulin and glucagon (no insulin)

• metabolic acidosis with increased ketone production.

• DKA often results in dehydration, electrolyte imbalances, and requires prompt medical treatment.

DKA Characteristics

• >300 mg/dL

• no insulin

• fat for energy

• cellular hypoglycemia

• ketones byproduct

• liver releases more glucose

• Glucosuria

• osmotic diuresis

Glucosuria

the presence of abnormal amounts of glucose in the urine

(typically greater than 0.25 mg/mL or 25 mg/dL in a fresh random sample).

osmotic diuresis

an increase in urination, caused by active non-reabsorbed solutes (like glucose or mannitol) trapped inside the fluid of the kidney tubules, which pulls and holds water in the urine.

ketones byproduct

metabolic byproducts produced by the liver when the body breaks down fat for energy instead of carbohydrates.

this process typically happens during fasting. carb restrictive diets (like keto), prolonged intense exercise, or when insulin levels are insufficient.

Precipitating Factors

• infection

• severe illness/stress

• inadequate insulin

• undiagnosed diabetes (type 1)

• lack of education, understanding, or resources

• neglect

Manifestations of DKA

• Polyuria- large volume of urine

• Polydipsia- excessive, unquenchable thirst

• Polyphagia- extreme hunger

• fruity breath

• dehydration- (dry mucous membranes, tachycardia, orthostatic hypotension)

• weakness

• vomiting

• abdominal pain

• confusion

• shock

• coma

From alertness to coma

Ketone buildup leads to metabolic acidosis (decreased blood pH) and compensatory Kussmaul respirations (deep, rapid breathing to exhale $CO_2$).

Initial Stage (danger)

• Airway

• LOC

• VS

• Glucose checks

• Hydration

• Electrolytes

• Insulin drip

#1 IV Fluids & Electrolyte Management

Watch for S/S of hypovolemia (low blood volume)

1. restore blood volume

2. maintain perfusion to vital organs

3. Bolus (0.45% or 0.9% NaCl)
   ▪ 15-20 mL/kg/hr. for 1st hr.

4. replace total body fluid loss

5. restore F&E imbalance

6. watch for fluid overload

7. Hyperkalemia is common

8. hypokalemia r/t insulin

9. CMP (comprehensive metabolic panel)

#2 Time for Insulin

1. regular insulin

2. initial IV bolus

3. continuous IV

4. Subcutaneous started after

5. Out of DKA

• Glucose <200 mg/dL

• Bicard (HCO3) >18 mEq/L

• Blood pH >7.30

• Anion Gap <12 mEq/L

• (Na+K) - (Cl+Bicarb)= Anion Gap (3-11)

Nursing Assessment while on DKA protocol

1. S/S of hypoglycemia

2. meals

3. glucose checks and confirmation

4. trends and times

5. titrate

6. Hold Insulin PRN

7. Continue protocol

8. call provider as needed