13. prioritize what would be your treatment steps when treating dka

Medication

Mar 25, 2021 · Your treatment will likely include: Replacing fluids you lost through frequent urination and to help dilute excess sugar in your blood. Replacing electrolytes (minerals in your body that help your nerves, muscles, heart, and brain work the way they should). Too little insulin can lower your electrolyte levels. Receiving insulin. Insulin reverses the conditions that …

Therapy

Oct 12, 2016 · 3. Take an increased dose of insulin. With diabetic ketoacidosis, your blood sugar becomes too high due to the lack of insulin. You may consider taking an increased dosage of insulin to help try to lower your blood sugar. Generally, you …

Self-care

Aug 20, 2020 · DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient's clinical and laboratory states.

Nutrition

Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the …

How do you manage diabetic ketoacidosis (DKA)?

Diabetic Ketoacidosis (DKA) is a potentially life threatening condition that occurs when excessive amounts of ketones are released into the bloodstream as a result of the body breaking down lipids, instead of utilising glucose as the energy source. ... ACTRAPID: Eight Steps For Managing Diabetic Ketoacidosis. CPDTime. 5m of CPD. Diabetic ...

What are the DKA management protocols in clinical care?

Treatment includes decreasing fluids (<70cc/kg/day or 0.75 X Maintenance) and giving Mannitol (1 gm/kg over 30 minutes), elevating the head of the bed, intubation and hyperventilation until a pCO2 level of 30-35 mmHg is reached may

How do I review a patient with DKA?

Maintain compliance with medication and insulin therapy. Maintaining a high blood glucose level, missing doses of insulin or being sick can cause ketones to form in the blood. Educate patients on healthy diet and lifestyle to prevent DKA. Teach patients and caregivers of the warning signs / symptoms of DKA.

When is potassium given to patients with diabetic ketoacidosis (DKA)?

Nov 12, 2021 · 2. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. 3. Using your thumbs, slightly open the mouth by downward displacement of the chin. Oropharyngeal airway (Guedel) Airway adjuncts are often helpful and in some cases essential to maintain a patient’s airway.

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How do you treat a patient with DKA?

What is the priority intervention for DKA?

What would be the priority nursing diagnosis for patient with DKA?

What are the goals of nursing management of the patient with diabetic ketoacidosis?

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.

How to prevent DKA?

Prevent DKA. DKA is a serious condition, but you can take steps to help prevent it: Check your blood sugar often, especially if you’re sick. Keep your blood sugar levels in your target range as much as possible. Take medicines as prescribed, even if you feel fine.

What causes DKA in diabetics?

Missing insulin shots, a clogged insulin pump, or the wrong insulin dose. Other causes of DKA include: Heart attack or stroke. Physical injury, such as from a car accident. Alcohol or drug use. Certain medicines, such as some diuretics (water pills) and corticosteroids (used to treat inflammation in the body).

What is DKA in diabetes?

DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones. When too many ketones are produced too ...

What does DKA mean in Spanish?

Español (Spanish) minus. Related Pages. Elevated ketones are a sign of DKA, which is a medical emergency and needs to be treated right away. Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes.

What is a DSMES referral?

If you’re concerned about DKA or have questions about how to manage your diabetes, be sure to meet with your diabetes care team and ask for a referral to diabetes self-management education and support ( DSMES) services for individual guidance. DSMES services are a vital tool to help you manage and live well with diabetes while protecting your health.

What to do if you can't get in touch with your doctor?

Go to the emergency room or call 911 right away if you can’t get in touch with your doctor and are experiencing any of the following:

What happens when you have too many ketones?

When too many ketones are produced too fast, they can build up to dangerous levels in your body. Read on to learn more about DKA, how you can prevent DKA, and how to treat it if needed.

How to prevent diabetic ketoacidosis?

Follow your diabetic management plan. One good way to prevent diabetic ketoacidosis is to follow your management plan. This includes making sure you eat a healthy diet and avoid foods that can affect your blood sugar level. [15]

How to treat ketoacidosis?

Increase your fluid intake. One of the first things that will be done to treat your diabetic ketoacidosis is to replace fluids. This can be in the hospital, a doctor’s office, or home. If you are receiving medical care, they will give you an IV. At home, you can drink fluids by mouth.

How does insulin help with ketoacidosis?

Undergo insulin therapy. Insulin helps reverse diabetic ketoacidosis. Insulin helps reduce the acid in your blood and balance your blood sugar level. This therapy is usually given intravenously by a medical professional.

How to lower blood sugar in diabetics?

With diabetic ketoacidosis, your blood sugar becomes too high due to the lack of insulin. You may consider taking an increased dosage of insulin to help try to lower your blood sugar.

What to do if your ketoacidosis is not working?

If you believe you have diabetic ketoacidosis and the at-home treatments have not worked, you should immediately go to the emergency room or call emergency services. If your blood sugar doesn't lower, your at-home treatments are not working, or your symptoms worsen, you should seek immediate medical attention.

What are the causes of ketoacidosis?

Some illnesses or infections can produce hormones like adrenaline and cortisol, which can block the effects of insulin. Missing treatments of insulin can also trigger diabetic ketoacidosis. Some medications or alcohol and drug abuse may also trigger the condition.

What electrolytes are needed for ketoacidosis?

Electrolytes, such as sodium, potassium, and chloride, are important to keep your body functioning properly. During diabetic ketoacidosis, your body doesn’t produce enough insulin, or the amount of insulin that your body needs has changed and you aren't giving it enough.

What should be included in a DKA test?

The initial laboratory testing should include plasma glucose, electrolytes, serum ketones (if unavailable, urine ketones can be obtained), complete blood count and initial arterial (or venous) blood gases. DKA is characterized by hyperglycemia, the presence of ketone bodies and acidosis. Plasma glucose is generally elevated to >13.9 mmol/L (250 mg/dL). However, a wide range of plasma glucose levels can be present, which is independent of the severity of DKA.[13] Normal or lower levels of glucose have been reported, a condition called “euglycemic DKA,” in about 10% of patients who present with DKA.[31] Patients who are prescribed SGLT2 inhibitor therapy may develop euglycemic DKA and the diagnosis of DKA can be missed or delayed in these cases; therefore, the physician should have a high level of suspicion when evaluating such patients.

Why is DKA important?

DKA continues to be an important cause of hospital admissions and mortality among patients with diabetes. Infections and nonadherence to insulin therapy remain the most common causes of DKA. Proper management of DKA includes prompt initiation of IV fluids, insulin therapy, electrolytes replacement and recognition and treatment of precipitating causes. Close monitoring of patient's condition by regular clinical and laboratory data and the use of management protocols help ensure better outcomes. Prevention of DKA through structured educational programs and identification of risk factors for recurrence should be part of the patient's care plan.

What is the DKA deficit?

DKA is associated with a significant total body deficit of serum electrolytes, particularly sodium, chloride and potassium. On average, patients with DKA have the following deficits of electrolytes per kilogram of body weight: sodium, 7–10 mEq/kg; potassium, 3–5 mEq/kg and chloride, 3–5 mmol/kg.[13,37] Replacement of sodium and chloride will follow the guidelines mentioned above.

What is DKA in diabetes?

Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death in patients with diabetes mellitus . DKA more commonly occurs among those with type 1 diabetes, yet almost a third of the cases occur among those with type 2 diabetes. Although mortality rates from DKA have declined to low levels in general, it continues to be high in many developing countries. DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient's clinical and laboratory states. The most common precipitating causes for DKA include infections, new diagnosis of diabetes and nonadherence to insulin therapy. Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors. Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA. Future episodes of DKA can be reduced through patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers. New approaches such as extended availability of phone services, use of telemedicine and utilization of public campaigns can provide further support for the prevention of DKA.

What is DKA in medical terms?

DKA is a medical emergency that requires prompt management in a hospital setting. The mainstays of its management include restoring the circulatory volume, correcting electrolyte abnormalities, treating hyperglycemia and diagnosing and treating the precipitating cause.

What is the importance of patient education?

Patient education is a critical part of the prevention of future hospital admissions for DKA. Educational programs should include guidelines on the management of diabetes during periods of illness (sick day management). These programs should include clear information on (1) the importance of continuing insulin, (2) early recognition of the manifestations of DKA, (3) more frequent home blood glucose and ketone (urine or blood) monitoring, (4) adjusting doses of insulin and the use of supplemental insulin, as needed and (5) instances when the health-care provider should be contacted.[13,37,75,76] Self-monitoring of blood ketones, when compared with urine ketone testing, facilitates earlier identification and treatment of ketosis, and can decrease diabetes-related emergency department visits and hospitalizations.[77,78] The frequency of recurrence of DKA can be reduced with structured patient education, behavioral intervention, providing support for patients and families, improving patients' access to medical providers, availability of extended access to telephone services and telemedicine.[79,80,81,82,83,84] In addition, public awareness campaigns focusing on education on the early signs of diabetes have been found to significantly reduce the frequency of DKA in patients with new onset diabetes.[85,86]

What is the second feature of DKA?

The second feature of DKA is the presence of ketones in the urine and/or serum. There are three types of ketones: beta-hydroxybutyrate, acetoacetate and acetone. It is recommended to measure serum beta-hydroxybutyrate (normal, <0.6 mmol/L) if urine ketones are negative when the diagnosis of DKA is suspected.[32] Point-of-care capillary beta-hydroxybutyrate measurement has been found to be both sensitive and specific for DKA when compared with ketone testing using the nitroprusside method.[33]

How long to treat diabetic ketoacidosis?

Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: Correction of electrolyte disturbances, particularly potassium loss. It is essential to maintain extreme vigilance for any concomitant ...

What is the role of intravenous fluids in DKA?

Fluid resuscitation is a critical part of treating patients with DKA. Intravenous solutions replace extravascular and intravascular fluids and electrolyte losses. They also dilute both the glucose level and the levels of circulating counterregulatory hormones. Insulin is needed to help switch from a catabolic state to an anabolic state, with uptake of glucose in tissues and the reduction of gluconeogenesis as well as free fatty acid and ketone production.

Why is insulin reduced in DKA?

Subcutaneous absorption of insulin is reduced in DKA because of dehydration; therefore, using intravenous routes is preferable. SC use of the fast-acting insulin analog (lispro) has been tried in pediatric DKA (0.15 U/kg q2h).

What electrolyte solution to use for dehydration?

If a patient is severely dehydrated and significant fluid resuscitation is needed, switching to a balanced electrolyte solution (eg, Normosol-R, in which some of the chloride in isotonic saline is replaced with acetate) may help to avoid the development of a hyperchloremic acidosis.

How much fluid should be used for cerebral edema?

The International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines suggest initial fluid repletion in pediatric patients should be 10-20 mL/kg of normal saline (0.9%) solution during the first 1-2 hours without initial bolus, and then, after 1-2 hours, insulin should be started to avoid pediatric cerebral edema. [ 31]

How much fluid is lost in acidosis?

Correction of fluid loss makes the clinical picture clearer and may be sufficient to correct acidosis. The presence of even mild signs of dehydration indicates that at least 3 L of fluid has already been lost.

When should insulin be taken after IV fluid replacement?

Insulin should be started about an hour after IV fluid replacement is started to allow for checking potassium levels and because insulin may be more dangerous and less effective before some fluid replacement has been obtained.

What is a DKA?

Diabetic Ketoacidosis (DKA) is a potentially life threatening condition that occurs when excessive amounts of ketones are released into the bloodstream as a result of the body breaking down lipids, instead of utilising glucose as the energy source. Please enable JavaScript to continue using this application.

How does insulin help with DKA?

The replacement of insulin is the cornerstone of rectifying DKA as it allows the uptake of glucose as an energy source, thereby reducing hyperglycaemia and stopping the pathophysiology of gluconeogenesis. However, blood glucose levels should not be decreased by more than three mmol/L per hour.

Why is potassium excreted in urine?

Due to the increased level of ketones in the body, there is an increased level of extracellular hydrogen ions (acidic) which are exchanged for intracellular potassium in an attempt to help the metabolic acidosis improve. Due to the osmotic diuresis observed in DKA , potassium is then excreted via the urine eventually leading to an overall depletion of potassium in both the intravascular and intracellular spaces. Potassium levels therefore need to be closely monitored and replaced as required, usually with an intravenous potassium infusion.

What is the term for the process of releasing ketones into the bloodstream?

This process is known as gluconeogenesis and occurs when the body does not have sufficient insulin ...

How much fluid is lost in DKA?

Due to the osmotic diuresis causing a large fluid depletion, fluid resuscitation is a must! The amount of fluid resuscitation required in severe DKA is often the amount of fluid that is lost (around six to ten litres).

What happens if you have DKA?

A decreased level of consciousness may lead to an unprotected airway and compromised breathing. The osmotic diuresis can cause a significant loss of fluid , leading to severe dehydration and circulatory collapse. Furthermore, severe electrolyte derangements significantly increase the risk of life threatening cardiac arrhythmias .

What are the complications of DKA?

Complications can include dehydration, hypovolaemia, hypotension, electrolyte abnormalities, cardiac arrhythmias, cardiac arrest and cerebral oedema. Information For Patients.

What are the factors that influence DKA?

Other important factors that can influence this are lifestyle factors. So, things like drinking too much alcohol and drug abuse. The desired outcome for a patient that’s in DKA is number one, to maintain blood glucose level within the target range, and then two, to maintain normal fluid balance.

What is DKA in a cold?

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.

What is DKA in diabetes?

Alright, so let’s take a look at what DKA actually is. So, it’s very important to know that this is a very serious complication of diabetes mellitus that can occur when blood sugars are poorly controlled. So, what happens is you get really increased blood sugar levels and they rise to an extreme level. So, they’re very, very high, but the body doesn’t have the insulin that it needs to use the glucose. So, this glucose and blood sugar is not accessible to the body. When that happens, the body has to start using fat for energy. So we’re not using blood sugar, we’re using fat for energy. When the body uses fat as an energy source, a type of acid called ketones actually builds up in the bloodstream, so you can see where the name for diabetic ketoacidosis comes from, again, acidosis that’s caused by these ketones that are building up secondary to using fat for energy.

Why do you give a medication to lower your glucose level?

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.

What is the primary indicator of ketone production?

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.

Why do diabetics get ketoacidosis?

Ketoacidosis can occur when diabetic patients experience emotional or physical stress such as with bacterial infections (UTI, etc), prolonged vomiting, surgery or when they miss doses of insulin. Alcohol and drug abuse in a diabetic patient can also cause the body to produce ketones that poison the blood.

What is the cause of ketoacidosis?

Diabetic ketoacidosis is a serious complication of diabetes mellitus that occurs when uncontrolled blood sugar rises and the body can’t produce enough insulin to use the glucose. When this happens, the body begins to break down fat as energy which produces a build-up of acid in the bloodstream called ketones.

Why is tachycardia common in DKA?

Tachycardia is common in the context of DKA due to hypovolaemia and catecholamine release. Bradycardia is a late sign and often precedes cardiac arrest. Hypovolaemia is common in the context of DKA due to reduced oral intake and vomiting.

When should antibiotics be administered?

If an infection is suspected , IV antibiotics should be administered as soon as possible.

Why is capillary refill time prolonged?

Capillary refill time may be prolonged if the patient is hypovolaemic.

How to introduce yourself to a patient?

Introduce yourself to the patient including your name and role.

What is an acute scenario?

Acute scenarios typically begin with a brief handover from a member of the nursing staff including the patient’s name , age , background and the reason the review has been requested.

Should doctors be made aware of patients who have recently deteriorated?

The next team of doctors on shift should be made aware of any patient in their department who has recently deteriorated.

Is it necessary to expose the patient during your assessment?

It may be necessary to expose the patient during your assessment: remember to prioritise patient dignity and conservation of body heat.