DKA

Type 1 DM

Lack of insulin

Impaired transport of
glucose to cells leading to
cell hunger

Metabolism of carbohydrates,
protein, and fats

Lipolysis causes relase of ketones as by

product

Increased Ketones in blood

Diabetic Ketoacidosis

Drugs:
 Insulin (NovoLog)- rapid acting insulin
 Insulin regular human (Humulin)-short acting insulin
 Potassium Chloride
 Sodium Bicarbonate- alkalinizing agents
Medical Management:
Treatment of DKA is aimed at correcting hyperglycemia,
dehydration, electrolyte loss and acidosis:
 Patients may need 6-10 L of Iv (0.9 Normal
saline to be infused at a high rate of 0.5 to 1 L/h
for 2-3 hours. Hypotonic (0.45%) NSS may be
used for hypertension or hypernatremia or
CHF. Plasma expanders may be used to correct
severe hypotension.
 Administer Potassium.
 Acidosis of DKA is reversed with insulin which
inhibits the breakdown of fat.
Nursing Interventions:
 Administer fluids as ordered. Monitor fluid volume
status, lung assessment and I&O.
 Assess for signs of infection and inflammation.
Observe aseptic technique during IV insertion and
medication administration.
 Teach patient about “sick day rules.” (Do not
eliminate insulin doses when nausea and vomiting
occurs; take insulin dose or previously prescribed
sick-day doses; check blood glucose level 3-4hours
Definition:
Is a serious complication of diabetes
type 1 which occurs when the body
produces high levels of blood acids
called ketones.
Diabetic Ketoacidosis
Nursing Diagnosis:
1. Risk for fluid volume deficit related to
polyuria and dehydration
2. Risk for infection related to high glucose
level
3. Deficient Knowledge related to diabetes
self-care skills/information
Risk factors:
 Diabetes type 1
 Decreased or missed dose of insulin
 Illness or infection
Clinical Manifestations:
 Polyuria and polydipsia (increased thirst)
 Blurred vision, weakness and headache
 Orthostatic hypotension with volume depletion
 Weak, rapid pulse
 GI symptoms such as anorexia, N& V and abdominal pain
 Acetone breath (fruity odor)
 Kussmaul respirations: hyperventilation with very deep, but
not labored respirations
 Mental status changes (alert to lethargic or comatose)
Laboratory and Diagnostic findings:
 Blood glucose level:300 to 800 mg/dL
 Low serum bicarbonate level: 0-15 mEq/L
 Low pH: 6.8 to 7.3
 Low pCO2: 10-30 mm Hg
 Sodium and potassium levels may be low, normal or high
depending on amount of water loss
 Elevated creatinine, BUN, hemoglobin, and hematocrit values
may be seen with dehydration. After rehydration, continued
elevation in the serum creatinine and BUN levels will be
present in the patient with underlying renal insufficiency.
HHNK
 Medical Management:
Risk factors:
 Start fluid treatment with 0.9& or 0.45 % normal saline, Definition:
 Age: 50-70 years of age who had no previous
depending on sodium level and severity of volume depletion. HHNKS is a serious condition in
history of diabetes or only mild type 2 diabetes.
 Central venous or arterial pressure monitoring may be which hyperglycemia and
 Can be precipitated by acute illnesses such as
necessary to guide fluid replacement hyperosmolarity predominate with
pneumonia, MI and stroke.
 Add potassium to replacement fluids when urinary output is alterations of the sensorium (sense of
awareness). Ketosis is minimal or  Ingestion of medications known to provoke insulin
adequate; guided by continuous ECG and laboratory
absent. The basic biochemical defect insufficiency (thiazide, diuretics, propanolol)
determinations of potassium.
 Therapeutic procedures such as peritoneal dialysis
 Give insulin at a continuous low rate is lack of effective insulin (insulin
or hemodialysis , hyperalimentation.
 Dextrose is added to replacement fluids when the glucose resistance).
level decreases to 250 to 300mg/dL

Clinical Manifestations:
Drugs:  History of days to weeks of polyuria and polydipsia
 Hypotension, tachycardia
 Insulin (NovoLog)- rapid acting insulin
 Insulin regular human (Humulin)-short acting insulin  Profound dehydration (dry mucous membrane, poor
skin turgor
 Potassium Chloride
Hyperglycemic  Variable neurologica signs (alterations of sensorium,
 Sodium Bicarbonate- alkalinizing agents
Hyperosmolar Nonketotic seizures, hemiparesis)
Syndrome (HHNKS)  Blood sugar level of 600 milligrams per deciliter
(mg/dL) or 33.3 millimoles per liter (mmol/L) or higher
 Fever and convulsions

Nursing Interventions:
Laboratory and Diagnostic Test:
 Monitor fluid volume and electrolyte status for prevention for
prevention of heart failure and cardiac dysrhythmias.  Blood work, including blood glucose, Nursing Diagnosis:
Administer fluid as indicated. electrolytes, blood urea nitrogen
 Assess for signs of infection and inflammation. Observe (BUN), complete blood count, serum 1. Risk for fluid volume deficit related to
aseptic technique during IV insertion and medication osmolality, and arterial blood gases. polyuria and dehydration
administration. Early initiation of antibiotic may help to  Physical and Mental Status 2. Risk for infection related to high
prevent sepsis. examination glucose level
 Reinforce that after recovery from HHNKS, many patients 3. Deficient Knowledge related to diabetes
can control diabetes with diet alone or diet and oral self-care skills/information
hypoglycemic agents.