DKA

what does DKA come from

decreased or absolute insulin deficiency

previous diabetes

when does BG increase the most

illness

injury

stress

surgery

what are the counterregulatory hormones that are released when BG goes up

glucagon

cortisol

catecholemines

growth hormone

physiological changes with DKA

hyperglycemia

osmotic diuresis

dehydration

hyperlipidemia

metabolic acidosis/ketosis

altered potassium balance

excess acids= increased anion gap

altered consciousness rt acidosis and dehydration

what is a normal anion gap

8-12

what are the causes of DKA

type I diabetes

infections, stress, illness

missed or reduced inuslin

glucocorticoids

signs of DKA

dehydration

polydipsia

polyuria

polyphagia

fruity breath

hyperventilation/kusmaal resps

flushed/dry skin

lethargy/altered consciousness

BG over 250

ketonuria/glucosuria

profound wt loss

metabolic acidosis

what BG is considered to be DKA

250 or higher

lower during pregnancy

which electrolyte disturbances are occurring

hyperkalemia

hypokalemia with insulin if not monitored properly

hypophosphatemia

mild hyponatremia

increased BUN and creatnine

what labs are checked with DKA

BMP

anion gap-reveals if there is metabolic acidosis

which molecules are included in the anion gap

sodium

chloride

bicarb

potassium

medications that affect glucose

thiazides

phenytoin

glucocorticoids

beta blockers

calcium channel blockers

enteral and parenteral nutrition

interventions for DKA

identify and treat any underlying infection

manage airway

fluid replacement

insulin therapy

bicarbonate

electrolyte replacement

monitor ECG

what does it mean if there are no ketones present in the urine but the BUN is high

dehydration

what needs to be monitored when given an insulin drip

potassium

normal potassium

3.5-5

normal phosphate

2.5-4.5

what are the top 2 nursing diagnoses

imbalanced fluid and electroltyes

imbalanced nutrition

normal magnesium range

1.7 and 2.2

what kinds of fluids are used to correct DKA

.9% NS then .45% NS

dextrose added when BG approaches 200

what should be monitored when giving fluids, and dextrose

cerebral edema and fluid volume overload

what are the considerations with using insulin

monitor potassium

give a loading dose in adults not kids

goal is to decrease BG by 50-75/hr

eventually transition to subq

goal is to bring the levels under 200

how often are BG’s checked when giving insulin

every hour

what criteria has to be met to transition to maintenance therapy of insulin

pH over 7.3

bicarb over 15

anion gap less than 12

ketosis must be resolved

when is bicarb used in this treatment

if the pH is less than 7.0

administered by infusion until pH is 7.1

is it more common with type 1 or 2

1

rapid or slow onset

rapid

what are the hallmark labs

ketones in blood and urine and increased BG in the blood

risk factors

infection

illness

stress

untreated or undiagnosed type I dm

which electrolyte is most important

potassium

when the patient presents to the ED with extremely high potassium what should be given

calcium gluconate to help protect the heart from dysrythmias