| Diabetic ketoacidosis or (DKA) is a complication of | | | | needle (18 to 20 gauge). Begin fluid stabilization with |
| diabetes. When the individual's blood sugar gets very | | | | 0.9 Normal Saline. This is an isotonic fluid, compatible |
| high and they are profoundly deficient in insulin, the | | | | with the body's pH. The purpose of using an isotonic |
| body becomes unable to utilize blood sugar efficiently. | | | | infusion initially is to re-establish blood pressure which |
| The body then begins to burn fat stores for food. | | | | was low and to increase urinary out put to 30-60ml |
| As these fat stores are burned, a by product is | | | | hr. When urinary output is less than 30 ml/hr, kidney |
| released called Ketones. It is ketones that are | | | | failure can rapidly occur. Fluids should continue for one |
| responsible for lowering the body's pH level below | | | | hour or until stabilization occurs. Next begin insulin |
| 7.35. Metabolic acidosis occurs when the pH of the | | | | infusion with a drip rate or 0.1U/kg/hr. During this time |
| body drops below 7.35. The body attempts to | | | | it is important to monitor the person's vital signs |
| excrete the ketones via the kidneys, causing | | | | every fifteen minutes until stable or for at least one |
| ketones to be released in the urine, a term called | | | | hours after treatment begins. If necessary, |
| ketonuria. However along with the negative ketones, | | | | potassium should be administered to correct for |
| the body's positively charged electrolytes are also | | | | hypokalemia, and sodium bicarbonate to correct for |
| excreted. This leads to an electrolyte imbalance. The | | | | metabolic acidosis, if the pH is less than 7.0. The |
| body continues to burn other glucose stores in the | | | | person should also have electrocardiogram leads |
| body such as proteins, causing nitrogen losses. | | | | placed on chest to monitor heart rhythms. |
| Now the body has depletion in electrolytes. This can | | | | When the diabetic is at home and feels these bodily |
| cause nausea and vomiting, depleting more | | | | signs and symptoms beginning to occur, they should |
| electrolytes. The individual is now in a severe | | | | take the following steps; call 911, check their blood |
| hyperglycemic state and is hypovolemic as well. If | | | | sugar, administer insulin per sliding scale, drink an |
| these conditions are left untreated, the person can | | | | electrolytic fluid, (i.e., sports fluids), breath into a |
| go into hypovolemic shock, become comatose and | | | | paper bag, use oxygen if available, lie down, raise |
| die. | | | | feet level with the heart and wait for the ambulance. |
| Outward signs and symptoms of DKA include the | | | | Preventative measures to avoid DKA include |
| following; eyeballs are soft and appear sunken, skin | | | | consistent control of blood sugar with administration |
| turgor is poor, (Dehydration of tissues can be tested | | | | of insulin per protocol. The diabetic should avoid too |
| by pinching the skin fold on the sternum. If the skin | | | | much food intake, and avoid taking too much or too |
| stays in one place or does not loose its shape rapidly, | | | | little insulin. Stressful life situations can also cause |
| then dehydration can be assumed.), the person is | | | | elevations in glucose levels. Therefore the diabetic |
| very pale, cold, clammy, and exhibits deep rapid | | | | should prepare to check their blood sugar more often |
| respirations, an effort the body makes to eliminate | | | | during times of stress and administer insulin as |
| excess carbon dioxide. The individual may also exhibit | | | | prescribed. |
| severe abdominal pain and tachycardia, (heart rate | | | | Understanding the complications of diabetes can help |
| greater than 100 beats per minute.) Diagnostic | | | | the diabetic take the necessary actions to prevent |
| laboratory findings from arterial blood gases would | | | | DKA from occurring and help them live a healthy life. |
| indicate a pH less than 7.35, blood glucose level | | | | References: |
| greater than 250 mg/dL, serum bicarbonate level less | | | | 1. Lewis, Heiitkemper, Dirkesen, Medical Surgical |
| than 15 mEq/L, as well as ketones in the urine. | | | | Nursing 6th ed., Copyright 2006, Mosby, St. Louis., |
| Interventions must be immediate to prevent | | | | pages 1273 -1278. |
| irreversible destruction to the body's organs and | | | | 2. |
| prevent coma or death. Ensure a patent airway, and | | | | 3. |
| begin to administer oxygen via nasal cannula or mask. | | | | 4. |
| Establish an intravenous access with a large bore | | | | |