diabetic ketoacidosis nursing management

YASH RAMAWAT M.N. FINAL

Diabetes meaning

a disorder of the metabolism causing excessive thirst and the production of large amounts of urine.

Ketoacidosis Pathological metabolic state associated

with high concentrations of ketone bodies

Meaning of diabetic ketoacidosis….

A serious pathological metabolic state in which excessive amount of keton bodies accumulate in body due to lack of insulin ……….

How lack of insulin develop acidosis

Insulin Deficiency

Glucose uptake Proteolysis Lipolysis

Amino Acids

GlycerolFree Fatty Acids

GluconeogenesisGlycogenolysis

HyperglycemiaKetogenesis

AcidosisOsmotic diuresis Dehydration

PATHOPHYSIOLOGY

Signs and Symptoms of DKA

• Polyuria, polydipsia– Enuresis

• Dehydration– Tachycardia– Orthostasis

• Abdominal pain– Nausea– Vomiting

• Fruity breath– Acetone

• Kussmaul breathing• Mental status

changes– Combative– Drunk– Coma

Counterregulatory Hormones - DKA

Increases insulin

resistance

Activates glycogenolysis

and gluconeogenesis

Activates lipolysis

Inhibits insulin secretion

Epinephrine X X X X

Glucagon XCortisol X XGrowth

Hormone X X X

IV FLUID

HYPOVOLUMIC SHOCK

ADMINISTER 0.9% NACL (1 LITER/ HR )

MILD HYPOTENSION

EVALUATE NA + LEVEL

NA HIGH NA NORMAL

0.45% NACL (4-14 ML/ KG / HR )

NA LOW

0.9% NACL (4-14 ML/ KG /

HR )

CARDIOGENIC SHOCK

HEMODYNAMIC MONITERING

Insuline

Intravenous route Insulin regular 0.15 U/kg b.

Wt. As iv bolus

0.1 u/kg/hr Iv insulin infusion

SC/IM routeInsulin regular 0.4 u/kg, ½ Iv

bolus , ½ im or sc

0.1 u/kg / hr regular insulin sc or im

If glucose does not fall by 50 –

70 mg

Double

insuline

infusion

hourly until

glucose fall

by 50-70

mg/dl

Give hourly

iv insulin bolus(10u) until

glucose fall

by 50-70

mg/dl

potassium

If serum K+ above 5 do not give k+ check it every 2hr

If serum potassium between 3.3 to 5 mEq/l then 20 mEq in each liter of iv fluid

Assess need for bicarbonate

pH < 6.9

NaHco3( 100 mmol ) dilute in

400 ml water at 200ml/hr

pH .>7 pH6.9-7.0NaHco3(

50 mmol ) dilute in 400 ml

water at 200ml/hr

Repeat HCO3

administration

q 2h untill pH > 7.0.

WHEN SERUM glucose reaches 250 mg/ dl

Change to 5% glucos with 0.45% Nacl at 150- 250 ml/hr with adequate insulin(0.05-0.1U/kg/hr insulin 5-10 U SC every 2 hr) to keep the

serum glucose between 150-250 mg/dl until metabolic control is achieved

Nursing Diagnosis

• FLUID VOLUME DEFICIT RELATED TO: OSMOTIC DIURESIS DUE TO HYPERGLYCEMIA, EXCESSIVE DISCHARGE: DIARRHEA, VOMITING; RESTRICTION INTAKE DUE TO NAUSEA, MENTAL MESS.

• MBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS RELATED TO: INSUFFICIENCY OF INSULIN, DECREASED ORAL INPUT, HIPERMETABOLISME STATUS

• RISK FOR INFECTION (SEPSIS) RELATED TO: INCREASED LEVELS OF GLUCOSE, DECREASED LEUKOCYTE FUNCTION, CHANGES IN THE CIRCULATION.

• RISK FOR SENSORY-PERCEPTUAL ALTERATIONS RELATED TO: KETIDKSEIMBANGAN GLUCOSE / INSULIN AND / OR ELECTROLYTES.

• FATIGUE RELATED TO: DECREASED METABOLIC ENERGY PRODUCTION, INSUFFICIENCY OF INSULIN, INCREASING ENERGY DEMAND.