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Management of adult diabetic ketoacidosis 1 Fluid therapy. 2 Insulin therapy. 3 Potassium, bicarbonate, and phosphate therapy. 4 Treatment of DKA in dialysis patients. 5 Metabolic treatment targets. 6 ... (more items)
How to manage adult diabetic ketoacidosis (DKA)?
This quiz on DKA ( Diabetic Ketoacidosis NCLEX Questions) will test you on how to care for the diabetic patient who is experiencing this condition. As the nurse, you must know typical signs and symptoms of DKA, patient teaching, and expected medical treatments.
What is DKA on the NCLEX?
During your nursing assessment, here are 7 lab values you’ll need to assess in a patient with DKA: 1. Blood glucose level: During diabetic ketoacidosis, the body cells can’t use glucose for energy.
What lab values should I assess in a patient with DKA?
If serum potassium decreases to <3.3 mEq/L during DKA treatment, insulin should be stopped and potassium administered intravenously. Small amounts of potassium (20–30 mEq/L) are routinely added to intravenous fluids when serum potassium is between 3.3 and 5.3 mmol/L. No replacement is needed for potassium levels >5.3 mmol/L.
When is potassium given to patients with diabetic ketoacidosis (DKA)?
What is the treatment for a patient with ketoacidosis?
Treatment usually involves: Fluid replacement. You'll receive fluids — either by mouth or through a vein — 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.
What is the most important treatment for DKA?
The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients.
What is the priority intervention for DKA?
After initial stabilization of circulation, airway, and breathing as a priority, specific treatment of DKA requires correction of hyperglycemia with intravenous insulin, frequent monitoring, and replacement of electrolytes, mainly potassium, correction of hypovolemia with intravenous fluids, and correction of acidosis.
What do you give a patient in DKA state?
Potassium, bicarbonate, and phosphate therapy If serum potassium decreases to <3.3 mEq/L during DKA treatment, insulin should be stopped and potassium administered intravenously. Small amounts of potassium (20–30 mEq/L) are routinely added to intravenous fluids when serum potassium is between 3.3 and 5.3 mmol/L.
What type of insulin is given for DKA?
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.
Why is insulin given in DKA?
Only short-acting insulin is used for correction of hyperglycemia in DKA. The optimal rate of glucose decline is 100 mg/dL/h. The blood glucose level should not be allowed to fall lower than 200 mg/dL during the first 4-5 hours of treatment.
What is the nurse's role in the management of the client and family experiencing diabetes ketoacidosis?
The nurse's role Some of the roles and responsibilities for nurses include: Ongoing clinical assessment of the patient: this involves regular (at least hourly) monitoring of vital signs and level of consciousness during the acute phase (JBDS, 2013).
How is HHS and DKA treated?
Early diagnosis and management is paramount to improve patient outcomes. The mainstays of treatment in both DKA and HHS are aggressive rehydration, insulin therapy, electrolyte replacement, and discovery and treatment of underlying precipitating events.
Can DKA be treated at home?
DKA can only be treated with insulin and fluids.
What are the therapeutic goals of DKA?
The therapeutic goals of DKA management include optimization of 1) volume status; 2) hyperglycemia and ketoacidosis; 3) electrolyte abnormalities; and 4) potential precipitating factors. The majority of patients with DKA present to the emergency room. Therefore, emergency physicians should initiate the management of hyperglycemic crisis while a physical examination is performed, basic metabolic parameters are obtained, and final diagnosis is made. Several important steps should be followed in the early stages of DKA management: 1 collect blood for metabolic profile before initiation of intravenous fluids; 2 infuse 1 L of 0.9% sodium chloride over 1 hour after drawing initial blood samples; 3 ensure potassium level of >3.3 mEq/L before initiation of insulin therapy (supplement potassium intravenously if needed); 4 initiate insulin therapy only when steps 1–3 are executed.
What is the protocol for the management of patients with DKA?
The protocol for the management of patients with DKA is presented in Figure 1. It must be emphasized that successful treatment requires frequent monitoring of clinical and metabolic parameters that support resolution of DKA (Table 1).
What is DKA in diabetes?
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.
How does volume resuscitation help with hyperglycemia?
Intravascular and extravascular volume resuscitation will decrease hyperglycemia by stimulating osmotic diuresis if renal function is not severely compromised and enhance peripheral action of insulin (insulin effects on glucose transport are decreased by hyperglycemia and hyperosmolarity). When glucose levels fall below 200–250 mg/dL, intravenous fluids should be switched to dextrose-containing 0.45% NaCl solution to prevent hypoglycemia, and/or insulin infusion rate should be decreased. Special considerations should be given to patients with congestive heart failure and chronic kidney disease. These patients tend to retain fluids; therefore, caution should be exercised during volume resuscitation in these patient groups. Urine output monitoring is an important step in patients with hyperglycemic crises.
How many hospitalizations for diabetic ketoacidosis in 2009?
In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis (DKA) with an average length of stay of 3.4 days.1The direct and indirect annual cost of DKA hospitalizations is 2.4 billion US dollars.
Why is bicarbonate not indicated in mild and moderate forms of DKA?
Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy.3, 8The use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies.
How much volume loss in DKA?
Fluid loss averages approximately 6–9 L in DKA. The goal is to replace the total volume loss within 24–36 hours with 50% of resuscitation fluid being administered during the first 8–12 hours. A crystalloid fluid is the initial fluid of choice.10Current recommendations are to initiate restoration of volume loss with boluses of isotonic saline (0.9% NaCl) intravenously based on the patient’s hemodynamic status.3Thereafter, intravenous infusion of 0.45% NaCl solution based on corrected serum sodium concentration will provide further reduction in plasma osmolality and help water to move into the intracellular compartment. Hyperosmolar hyponatremia due to hyperglycemia is a frequent laboratory finding in DKA and is usually associated with dehydration and elevated corrected sodium concentrations.
What is a DKA quiz?
This quiz on DKA ( Diabetic Ketoacidosis NCLEX Questions) will test you on how to care for the diabetic patient who is experiencing this condition. As the nurse, you must know typical signs and symptoms of DKA, patient teaching, and expected medical treatments.
What should the potassium level be during treatment of DKA?
D. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy.
How often should I check my blood glucose?
C. “It is important I check my blood glucose every 3-4 hours when I’m sick and consume liquids.”
Is hyperglycemic ketoacidosis a complication of diabetes mellitus?
Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) are both complication of diabetes mellitus, but there are difference s between the two complications that you must know as a nurse . This endocrine teaching series will test your knowledge on how to differentiate between the two conditions, along with a video lecture.
What should be included in a DKA workup?
DKA work-up should include CBC, electrolytes, extended electrolytes, creatinine, BUN, albumin, VBG, lactate, serum ketones, as well as consideration for: Lactate is a potentially important prognostic factor in predicting the severity of DKA and in monitoring the progression or resolution.
How to avoid cerebral edema in the management of DKA?
The key to avoiding cerebral edema in the management of DKA is to go slow with resuscitation.
What is euglycemic DKA?
Euglycemic DKA involves a relative carbohydrate deficiency state/normalization of serum glucose and concomitant elevation of counter-regulatory stress hormones that leads to free fatty acid catabolism and ketone production.
Why is DKA a precipitating cause?
Most often, it is due to medication non-adherence, incorrect dosing or infection.
Why is potassium high in DKA?
However, the initial potassium reading is commonly normal or high due to intracellular shifts secondary to volume contraction and metabolic acidosis. Potassium must be replaced prior to initiation of insulin therapy as insulin further promotes an intracellular shift of potassium.
When to add dextrose to IV fluid?
Add dextrose (D5W) to the IV fluid if/when blood glucose approaches normal to allow continued insulin infusion at a rate sufficient to resolve DKA while avoiding hypoglycemia OR when glucose <15 (250-300mg/DL) switch to D5-1/2NS NS at an initial rate of 150 to 250 mL/h
What drugs can trigger DKA?
In addition, common drugs that can trigger DKA include glucocorticoids, diuretics and atypical antipsychotics.
What should the potassium level be during treatment of DKA?
D. Potassium levels should be at least 3.3 or higher during treatment of DKA with insulin therapy.
What does oliguria mean in DKA?
Oliguria means low urinary output. ...in DKA you have high urinary ouput (POLYURIA). 2. A patient is admitted with Diabetic Ketoacidosis. The physician orders intravenous fluids of 0.9% Normal Saline and 10 units of intravenous regular insulin IV bolus and then to start an insulin drip per protocol.
Why should I not be alarmed if ketones are present in my urine?
D. "I should not be alarmed if ketones are present in my urine because this is expected during illness."
Does insulin lower potassium levels?
Insulin causes potassium to enter back into the cell; therefore removing it from the blood. If the potassium is already 2.3, the patient can bottom out their potassium level. Therefore, the patient needs potassium supplements which requires a doctor's order.
What is the blood glucose level of a DKA patient?
1.) A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose.
What does a cardiac monitor show when a diabetic ketoacidosis patient is receiving insulin?
The cardiac monitor shows the appearance of a U wave. What complication does the nurse suspect?
What is the normal pH for ketoacidosis?
1.) A client in diabetic ketoacidosis will have blood gas readings that indicate metabolic acidosis. The pH will be acidic (7.30), and the HCO 3 - will be low (20 mEq/L [20 mmol/L]). The normal pH is 7.35 to 7.45; CO 2 ranges from 35 to 45 mm Hg, and HCO 3 - ranges from 22 to 26 (22 to 26 mmol/L). A pH of 7.35 and a CO 2 of 47 mm Hg indicate respiratory acidosis. pH values of 7.46 and 7.50 represent alkalosis, not acidosis.
What is the potassium level of a diabetic ketoacidosis patient?
The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5 .4 mmol/L). What would the nurse expect to see on the ECG tracing monitor?
Why is bicarbonate acidosis decreased?
Correct4) The bicarbonate-carbonic acid buffer system helps maintain the pH of body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids. The pH is decreased. The PO 2 is not decreased in diabetic acidosis. The PCO 2 may be decreased by the body's attempt to eliminate CO 2 to compensate for a decreased pH.
Why is serum lipids high in diabetics?
1.) With diabetic ketoacidosis, serum lipid levels are high because of the increased breakdown of fat. Serum lipid levels can go so high that the serum appears opalescent and creamy. With diabetic ketoacidosis the hematocrit level generally is increased because of dehydration. The calcium level is unrelated to diabetic ketoacidosis. With diabetic ketoacidosis the blood urea nitrogen level generally is increased because of dehydration.
When is potassium used up?
Potassium is quickly used up during the rapid series of catabolic reactions stimulated by insulin and glucose.
Why do diabetics need to keep an eye on their glucose levels?
So you’ll need to keep an eye on their blood glucose level because it can be elevated during diabetic ketoacidosis.
Why do ketones show up in urine?
And when fat is broken down, ketones are released. These ketones will show up in the urine in a patient with diabetic ketoacidosis because there will be ketones circulating in the body.
Why does hyperglycemia occur in diabetics?
And when fat is broken down, acids are released, and these acids are called ketones. Hence the name, ketoacidosis. So because the cells can’t use glucose for energy, the glucose just hangs out in the blood, and this leads to hyperglycemia . So you’ll need to keep an eye on their blood glucose level because it can be elevated during diabetic ketoacidosis.
Why does potassium drop so fast?
However, during treatment, once DKA is getting under control, and the blood glucose level starts to go down, that blood potassium level can drop really fast because potassium moves back into the cell once the party’s over. So when all the glucose leaves, potassium leaves too, it goes back inside the cell.
Does potassium decrease with insulin?
When your patient is treated for DKA (especially with insulin), the potassium level will decrease . You MUST be aware of this in nursing school when you’re treating a patient with DKA. Always assess their potassium lab value throughout treatment to make sure their potassium level stays within normal range. 5.
Does potassium increase during ketoacidosis?
Potassium (this is a KEY POINT!): Potassium usually hangs out inside of cells. But during hyperglycemia, it moves outside of the cells. This causes the potassium lab value to increase during diabetic ketoacidosis. When your patient is treated for DKA (especially with insulin), the potassium level will decrease.
What is the first line of treatment for newly diagnosed Type 2 diabetics?
D. Oral medications are the first line of treatment for newly diagnosed Type 2 diabetics.
What to do if your glucose is less than 200?
A. "I will check my blood glucose prior to exercise. If it is less than 200 I will eat a complex carb snack prior to exercising."
Is ketone present in DKA?
B. Ketones are present in the urine in DKA.
Is insulin a type 2 medication?
A. Insulin and oral diabetic medications are administered routinely in the treatment of Type 2 diabetes.