What is the correct nursing treatment for diabetic ketoacidosis?
Insulin therapy. Insulin reverses diabetic ketoacidosis. In addition to fluids and electrolytes, insulin is given, usually through a vein. A return to regular insulin therapy may be possible when the blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and the blood is no longer acidic.
What is the treatment for suspected ketoacidosis?
Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.
What does the hospital do for ketoacidosis?
Treatment for DKA If you have DKA, you'll be treated in the emergency room or admitted to the hospital. Your treatment will likely include: Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood.
What is the priority intervention for a patient with diabetic ketoacidosis?
The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution.
How do you get someone out of ketoacidosis?
DKA can only be treated with insulin and fluids. These are often given in a vein (IV). Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems.
Which insulin is used for ketoacidosis?
Regular and glulisine insulin are equally effective during the acute treatment of DKA. A transition to subcutaneous glargine and glulisine after resolution of DKA resulted in similar glycemic control but in a lower rate of hypoglycemia than with NPH and regular insulin.
How long does it take to treat ketoacidosis?
DKA is fully treated when your blood sugar is less than 200 mg/dL and your blood pH is higher than 7.3. DKA is usually corrected within 24 hours. Depending on the severity of the DKA, it could take multiple days before the DKA is fully treated and you can leave the hospital.
What blood sugar level is ketoacidosis?
1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible. 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately.
Do you go to ICU for ketoacidosis?
It is treated commonly in the intensive care unit (ICU), even though clinical data from many studies support management in regular (medical/surgical) wards, avoiding expensive critical care unit costs and preventing bed crisis in these higher level of care units for sicker patients.
Which nursing action is most appropriate for a client in ketoacidosis?
Acute Confusion Interventions IV insulin is the standard treatment for DKA as the patient needs insulin rapidly to decrease glucose and ketone levels.
What are the three key actions for the management of DKA?
Key DKA management points Start intravenous fluids before insulin therapy. Potassium level should be >3.3 mEq/L before the initiation of insulin therapy (supplement potassium intravenously if needed). Administer priming insulin bolus at 0.1 U/kg and initiate continuous insulin infusion at 0.1 U/kg/h.
What IV fluid is best for DKA?
Saline (0.9% sodium chloride, also called normal saline) is the most commonly used fluid for this purpose and the primary fluid recommended in current DKA clinical practice guidelines.
Can ketoacidosis be treated at home?
Your body needs insulin to decrease blood sugar levels. Sometimes, too much insulin can cause low blood sugar (hypoglycemia). If this happens and you're treating your DKA from home, you'll need to treat the low blood sugar by consuming sugar or carbohydrates per your healthcare provider's instructions.
What are the two 2 main triggers for diabetic ketoacidosis?
People with type 2 diabetes can also develop DKA, but it is less common and less severe. It is usually triggered by prolonged uncontrolled blood sugar, missing doses of medicines, or a severe illness or infection.
How long does it take to treat ketoacidosis?
How long does it take to recover from diabetic ketoacidosis? Finally, some good news! Once you're safely admitted to the hospital for DKA, recovery is usually complete in one to three days.
What is a diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit (ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding.
What is DKA in diabetes?
DKA causes an acute metabolic disorder, which is primarily characterized by an increased presence of circulating ketone bodies, and the development of severe ketoacidosis in the presence of prolonged uncontrolled hyperglycemia, usually due to insulin deficiency[3]. It is more commonly seen in patients with insulin-dependent diabetes mellitus (IDDM), especially among children and young adults. Occasionally, patients with insulin resistant DM can present this complication; especially those that are noncompliant with insulin therapy or who present severe infection[3]. DKA has arbitrarily been classified by some as mild, moderate and severe, according to the initial diagnostic criteria (which includes plasma glucose, arterial pH, serum bicarbonate, urine and serum ketones, serum osmolality and anion gap; and the alteration in the mental status)[4].
Can DKA be treated in the ICU?
In many institutions, and for decades, DKA has been routinely treated in ICU environments, including recommendations by the American Diabetes Association guidelines for DKA treatment[3,4,7-9]. The primary reason for these level of care requirements, has been the presence of severe metabolic acidosis, even if patients are grouped as mild or moderate in severity[10]. Frequent blood glucose monitoring, the need for intravenous insulin infusions, and the requirement of frequent vital signs is cited as the hospital structural requirements for this ICU level of care[11]. However, several studies have shown that DKA can be safely treated in the ED or even in medical wards (Table (Table11)[12-17]. By taking this lower level of care approach, we can potentially avoid ICU hospitalization rate and higher costs, bed overcrowding and reserving the beds for patients who present complications such as hypotension, coma, acute myocardial ischemia, or those with several comorbidities (i.e., end-stage renal disease, congestive heart failure) and anyone categorized as suffering severe DKA[12,18,19]. In some observational studies DKA patients admitted to the ICU have a shorter length of stay when compared to non-diabetic mellitus ICU patients[20,21]. A recent retrospective cohort study of 156, 842 hospitalizations among 94 acute-care hospitals, analyzed the adjusted cost of hospitalizations in lower and higher ICU utilizations groups, and concluded that the overuse of ICU only increases the cost and the utilization of invasive procedures but with no improvement in hospital mortality[22].
How can clinicians help patients in the ED?
By establishing a rapid diagnosis and starting treatment in the ED, clinicians can help patients to decrease their costs and hospital stay.
Is ketoacidosis a complication?
Core tip:Diabetic ketoacidosis is a complication for some patients with insulin-dependent diabetes mellitus as well as for non-insulin dependent. It is treated commonly in the intensive care unit (ICU), even though clinical data from many studies support management in regular (medical/surgical) wards, avoiding expensive critical care unit costs and preventing bed crisis in these higher level of care units for sicker patients. Once the patient is treated, adequate follow up and education is mandatory. Noncompliance remains the primary concern for repeated admissions.
Do you need to switch to IV insulin?
No need to switch to IV regular insulin, no hypoglycemic events, no complications, no recurrence of ketoacidosis and no mortality
Is DKA a benefit of ICU?
The benefit of ICU level of care for patients with DKA rather than regular medical/surgical wards is not well established for patients with mild-to-moderate DKA. Many studies suggest the utilization of the ED or the regular (medical/surgical) wards in the management of these patients. There is significant cost-benefit in managing DKA in the ED and regular wards instead of the ICU, where only patients that require life-supportive intervention should go. Once patients are discharged from the hospital adequate follow up is necessary to avoid readmissions and assure compliance.
What is a nursing care plan for diabetic ketoacidosis?
The nursing care plan for clients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome includes provision of information about disease process/prognosis, self-care, and treatment needs, monitoring and assistance of cardiovascular, pulmonary, renal, and central nervous system (CNS) function , avoiding dehydration, and correcting hyperglycemia and hyperglycemia complications.
What is a diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a life-threatening emergency caused by a relative or absolute deficiency of insulin. This deficiency in available insulin results in disorders in the metabolism of carbohydrate, fat, and protein. Main clinical features of DKA are hyperglycemia, acidosis, dehydration, and electrolyte losses such as hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, and hypophosphatemia.
What is a DKA?
ADVERTISEMENTS. Diabetic ketoacidosis (DKA) is a life-threatening emergency caused by a relative or absolute deficiency of insulin. This deficiency in available insulin results in disorders in the metabolism of carbohydrate, fat, and protein. Main clinical features of DKA are hyperglycemia, acidosis, dehydration, ...
Why add dextrose to IV fluid?
Dextrose is added to prevent the occurrence of hypoglycemia and an excessive decline in plasma osmolality that can result in cerebral edema. Administer IV potassium and other electrolytes as indicated.
Why is potassium added to IV?
Potaasium is added to the IV once serum potassium drops below 5.5 mEq/L to prevent hypokalemia. The administration of insulin to lower blood glucose promotes the movement of potassium intracellularly.
What to do if you have diabetic ketoacidosis?
If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and order blood tests. In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis.
What tests are done to determine if you have ketoacidosis?
Tests might include: Blood electrolyte tests. Urinalysis. Chest X-ray.
What blood test is used to diagnose ketoacidosis?
Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level.
What happens when you have excess ketones in your blood?
Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body.
Is ketoacidosis life threatening?
Diabetic ketoacidosis is life-threatening. If you develop mild signs and symptoms, contact your doctor immediately.
What are the main interventions for DKA?
There are 3 main nursing interventions for DKA: fluids, insulin, and of course, continuing to assess your patient!
What is the nursing assessment for DKA?
Nursing assessment for DKA: There are several key nursing assessments you’ll need to for a patient with DKA, which may include: monitoring their intake and output, weight checks, assessing respiratory status, assessing their IV site and fluids, drawing labs, and assessing their mental status.
Why does DKA cause hyperglycemia?
This causes hyperglycemia, because there isn’t any insulin around to move glucose into the cells, so all of that glucose just builds up and builds up in the blood. It can’t get into the cell, it’s stuck outside!
Why does DKA happen in type 1 diabetes?
So that’s why it mostly happens in type 1 diabetes. During type 2 diabetes, the cells become resistant to insulin.
What is the key point of ketoacidosis?
And here’s a KEY POINT you need to know about diabetic ketoacidosis: when fat is converted into energy, ketones are produced, and ketones are acids. This is step 4, ketones are produced as a biproduct of fat metabolism. This is a key point to remember for DKA: the cells use FAT for energy instead of glucose. And when fat is broken down, ketones are ...
Why do cells have DKA?
Glucose is the cells best energy source, so without insulin, the cells can’t get any glucose. So because the cells don’t have insulin, the cells start converting fat into energy instead.
What is the step number 5 of DKA?
And when fat is broken down, ketones are released, and ketones are ACIDS. And because there’s all that acid release, it leads to step number 5, which is acidosis.
What is a DKA in nursing?
NCLEX review on Diabetic Ketoacidosis for nursing lecture exams and the NCLEX exam. DKA is a life-threatening condition of diabetes mellitus. It is important to know the differences between diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) because the two complications affect the diabetic patient.
What are the symptoms of ketoacidosis?
Signs & Symptoms of Diabetic Ketoacidosis: Recap of what is going on: Hyperglycemia (intracellular to extracellular shifting takes place which will lead to electrolyte imbalances) Ketones in the blood (leads to metabolic acidosis, weight loss because of all the fat burning, electrolyte shifting as well)
How often should you monitor glucose and ketones?
Monitor glucose and ketones during illness every 4 hours, especially if dealing with illness/infection
Why do diabetics have ketones?
The patient will experience increased ketones in the body which are LIFE-THREATENING to a diabetic patient because it causes the blood to become acidic ( metabolic acidosis) Kidneys: plays a role in reab sorbing glucose in the renal tubules. However, there is too much glucose present in the blood and it cannot be reabsorbed.
What causes DKA?
Causes of DKA. Undetected diabetes: patient doesn’t know they are diabetic and this is the first sign, usually. More Insulin needed by the body than normal: the body needs more units of insulin than it is actually receiving from injections.
What are the key players in DKA?
Key Players of DKA: Glucose: fuels the cells so it can function. However, with DKA there is no insulin present to take the glucose into the cell…so the glucose is not used and the patient will experience hyperglycemia >300 mg/dL. Insulin: helps take glucose into the cell so the body can use it for fuel. In DKA, the body isn’t receiving enough ...
How to manage ketoacidosis in nursing?
Maintain blood glucose level within the target range, maintain normal fluid balance Diabetic Ketoacidosis (DKA) Nursing Care Plan Metabolic Acidosis with elevated Anion Gap Monitor blood glucose levels and administer insulin as appropriate Consistently high blood glucose levels, over 400 mg/dL, are the primary indicator of ketone production. Monitor glucose and intervene with prescribed insulin as appropriate to reduce glucose levels and prevent further ketone production. Monitor fluid and electrolyte balance to prevent dehydration and complications such as decreased sodium, potassium, calcium and magnesium Excess blood glucose can cause nausea and vomiting resulting in electrolyte imbalances. These electrolyte deficiencies can lead to further complications and cardiac arrhythmias. Monitor for and treat signs / symptoms of infection DKA is often the result of an underlying infection such as a common cold, flu or bacterial infection like pneumonia or urinary tract infections. Assess for fever and other symptoms of infection and administer antibiotics as necessary. Medications may be given to lower the blood glucose level in order to prevent further production of ketones or to manage symptoms of vomiting and underlying infection. Monitor vitals for signs / symptoms of hypovolemia Vomiting and frequent urination can cause a deficiency in fluid volume, thus leading to a decreased circulatory volume. This will be evident by low blood pressure and tachycardia Prevent injury and falls; assist with ambulation Fatigue and weakness are common due to the cells inability to use glucose to produce energy, also following vomiting, and in cases of dehydration. Maintaining a high blood glucose level, missing doses of insulin or being sick can cause ketones to form in the blood. Educat Continue reading >>
What is a DKA in nursing?
NCLEX review on Diabetic Ketoacidosis for nursing lecture exams and the NCLEX exam. DKA is a life-threatening condition of diabetes mellitus. It is important to know the differences between diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) because the two complications affect the diabetic patient. However, there are subtle difference between the two conditions. Don’t forget to take the DKA Quiz. In these notes you will learn about: Key Player of DKA Causes of DKA Signs and Symptoms of DKA Nursing Interventions of DKA Lecture on Diabetic Ketoacidosis Diabetic Ketoacidosis Define: a complication of diabetes mellitus that is life-threatening, if not treated. It is due to the breakdown of fats which turn into ketones because there is no insulin present in the body to take glucose into the cell. Therefore, you will see hyperglycemia and ketosis and acidosis. Key Players of DKA: Glucose: fuels the cells so it can function. However, with DKA there is no insulin present to take the glucose into the cell…so the glucose is not used and the patient will experience hyperglycemia >300 mg/dL. Insulin: helps take glucose into the cell so the body can use it for fuel. In DKA, the body isn’t receiving enough insulin…so the GLUCOSE can NOT enter into the cell. The glucose floats around in the blood and the body starts to think it is starving because it cannot get to the glucose. Therefore, it looks elsewhere for energy. Liver & Glucagon: the body tries an attempt to use the glucose stores in the liver (because it doesn’t know there is a bunch of glucose floating around in the blood and thinks the body is experiencing hypoglycemia). In turn, the liver releases glucagon to turn glycogen stores into more GLUCOSE….so the patient becomes even more hyp Continue reading >>
What is DKA in diabetes?
Go to: Abstract Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management. Keywords: DKA treatment, insulin, prevention, ESKD Go to: Introduction In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis (DKA) with an average length of stay of 3.4 days.1 The direct and indirect annual cost of DKA hospitalizations is 2.4 billion US dollars. Omission of insulin is the most common precipitant of DKA.2,3 Infections, acute medical illnesses involving the cardiovascular system (myocardial infarction, stroke) and gastrointestinal tract (bleeding, pancreatitis), diseases of the endocrine axis (acromegaly, Cushing’s syndrome), and stress of recent surgical procedures can contribute to the development of DKA by causing dehydration, increase in insulin counter-regulatory hor Continue reading >>
What is DKA in medicine?
One of the most severe complications of diabetes, diabetic ketoacidosis (DKA), results from insulin deficiency and is a medical emergency that is frequently encountered in the emergency department. Prompt diagnosis, assessment of key laboratory values, appropriate treatment, and close monitoring are important to the successful treatment of this complex metabolic disorder. Fluid repletion and insulin administration are mainstays of DKA treatment and serve to restore normal hemodynamic status while decreasing the metabolic acidosis. Careful monitoring of glucose concentrations, vital signs, and electrolytes is essential to prevent complications arising from the treatment of DKA. This article provides an overview of the pathophysiology, presentation, diagnosis, treatment, monitoring, and complications of DKA. Emory University Hospital; and Mercer College of Pharmacy and Health Sciences, Atlanta, GA. Corresponding Author: Stacey Folse, PharmD, MPH, BCPS, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322 ( [email protected] ). Disclosure: The authors report no conflicts of interest. DIABETES is a chronic condition that affects 25.8 million people (8.3%) in the United States. Of these, 7 million cases are undiagnosed. Diabetes continues to increase in prevalence, with the most recent data indicating that 1.9 million people were newly diagnosed in 2010 ( Centers for Disease Control and Prevention, 2010 ). Two of the most serious and life-threatening complications of diabetes are diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state. This Continue reading >>
How to diagnose diabetic ketoacidosis?
In some cases, additional tests may be needed to help determine what triggered the diabetic ketoacidosis. Blood tests Blood tests used in the diagnosis of diabetic ketoacidosis will measure: Blood sugar level. If there isn't enough insulin in your body to allow sugar to enter your cells, your blood sugar level will rise (hyperglycemia). As your body breaks down fat and protein for energy, your blood sugar level will continue to rise. Ketone level. When your body breaks down fat and protein for energy, acids known as ketones enter your bloodstream. Blood acidity. If you have excess ketones in your blood, your blood will become acidic (acidosis). This can alter the normal function of organs throughout your body. Additional tests Your doctor may order tests to identify underlying health problems that might have contributed to diabetic ketoacidosis and to check for complications. Tests might include: Blood electrolyte tests Urinalysis Chest X-ray A recording of the electrical activity of the heart (electrocardiogram) Treatment If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves: Fluid replacement. You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes throu Continue reading >>
What is DKA in medical terms?
INTRODUCTION Diabetic ketoacidosis (DKA) is a very serious complication of diabetes mellitus, a metabolic disorder that is characterized by hyperglycemia, metabolic acidosis, and increased body ketone concentrations. The most common causes of DKA are infection and poor compliance with medication regimens. Other causes include undiagnosed diabetes, alcohol abuse, and a multitude of medical conditions such as cerebrovascular accident (CVA), complicated pregnancy, myocardial infarction, pancreatitis, and stress. Diabetic ketoacidosis is a complicated pathology. Early recognition of DKA, a good understanding of the pathological processes of DKA, and aggressive treatment are the keys to successful treatment. With good care, DKA can be managed and the patient will survive. OBJECTIVES When the student has finished studying this module, he/she will be able to: 1. Identify the correct definition of DKA. 2. Identify a basic function of insulin. 3. Identify the insulin derangements of types I and II diabetes. 4. Identify the basic cause of DKA. 5. Identify two specific causes of DKA. 6. Identify the two pathogenic mechanisms that produce the signs/symptoms of DKA. 7. Identify metabolic consequences of increased hormone concentrations in DKA. 8. Identify the criteria used to diagnose DKA. 9. Identify common signs and symptoms of DKA. 10. Identify laboratory abnormalities seen in DKA. 11. Identify complications of DKA. 12. Identify the three most important therapies for treating DKA. 13. Identify the correct roles of sodium bicarbonate and phosphate in treating DKA. 14. Identify an important rule for using potassium replacement in DKA. 15. Identify an important rule for switching from IV to subcutaneous insulin. EPIDEMIOLOGY Most cases of DKA are seen in patients with type I diabete Continue reading >>
Is ketoacidosis a life threatening condition?
Diabetic ketoacidosis is a potentially life-threatening complication of diabetes, making it a medical emergency . Nurses need to know how to identify and manage it and how to maintain electrolyte balance Continue reading >>
