Understanding Diabetic Ketoacidosis (DKA)

Jan 15, 2025

Lecture on Diabetic Ketoacidosis (DKA)

Introduction

  • Speaker: Sarah from RegisteredNurseAriene.com
  • Topic: Diabetic Ketoacidosis (DKA)
  • Part of an endocrine series on diabetes.
  • Additional content on Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS) and comparison with DKA to follow.
  • Encourages visiting website for a quiz on DKA.

Definition of DKA

  • DKA: A life-threatening condition mostly in diabetic patients due to lack of insulin.
  • Insulin is crucial for glucose utilization by cells.
  • Absence of insulin leads to fat breakdown, releasing ketones.
  • Key Components: Hyperglycemia, Ketosis, Acidosis.

Pathophysiology

  • Glucose: Essential for cellular energy but remains in blood due to lack of insulin.
    • Blood sugar > 300 mg/dL.
  • Insulin: Absent in DKA, prevents glucose from entering cells.
  • Liver & Glucagon: Misunderstand body signals, increase blood glucose by releasing glycogen.
  • Breakdown of Fats: Leads to ketone production, causing blood acidity.
  • Kidneys: Fail to reabsorb glucose, leading to osmotic diuresis and electrolyte imbalance.

Typical Patient Profile

  • Occurs mostly in Type 1 diabetics, rarely in Type 2 diabetics unless during severe illness.

Causes of DKA

  • Undetected Diabetes: Initial symptom in undiagnosed diabetics.
  • Increased Insulin Demand: Illness, stress, corticosteroids, or thiazide diuretics.
  • Skipping Meals: Leads to starvation mode, fat breakdown into ketones.
  • Non-compliance with Insulin: Lack of understanding or adherence results in high glucose levels.

Signs and Symptoms

  • Hyperglycemia: High blood glucose, cellular dehydration, electrolyte shifts.
  • Ketones in Blood: Weight loss, metabolic acidosis, fruity breath.
  • Acidosis: pH < 7.35, low bicarbonate, Kussmaul breathing.
  • Sudden Onset: Unlike gradual HHNS onset.
  • Polyuria: Due to osmotic diuresis.
  • Polydipsia and Dehydration: Excessive thirst and fluid loss.
  • Nausea/Vomiting/Abdominal Pain: Especially in pediatric patients.
  • Tachycardia and Hypotension: Due to dehydration.
  • Fatigue and Confusion.

Nursing Interventions

  • Education:
    • Monitor glucose and urine ketones every 4 hours when sick.
    • Notify doctor if unable to eat/drink, have high glucose, or ketones.
  • Pharmacological Goals:
    • Hydration, blood sugar reduction, potassium level monitoring, acid-base correction.

Medication Management

  • IV Fluids: Begin with isotonic saline, possibly switch to hypotonic solutions.
  • Insulin Administration:
    • Only regular insulin IV.
    • Check potassium levels (>3.3) before administration.
    • Insulin drip titrated based on glucose readings.
    • Monitor for hypokalemia.
  • Potassium Monitoring:
    • Monitor ECG and renal function.

Conclusion

  • Encourages taking the DKA quiz on the website.
  • Upcoming video on HHNS.
  • Call to subscribe to YouTube channel.