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.