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Understanding Dka For Nurses

Differentiating Diabetes Complications: Whats Your Call?

Differentiating Diabetes Complications: Whats Your Call?

Differentiating diabetes complications: Whats your call? Author: Cynthia Ticker, RN, BSN, CDE, CPT Carlos Suarez, age 74, arrives at the emergency department by ambulance after collapsing at home. Emergency personnel report that he is confused and cant tell them what caused his collapse. His vital signs are temperature 102.4 F, respirations 22 breaths/minute, pulse 110 beats/minute, and blood pressure 90/60 mm Hg. He has dry mucous membranes, poor skin turgor, and bilateral wheezing in both lungs. A fingerstick blood glucose level reads high on the meter, indicating a value above 600 mg/dl. Mr. Suarezs wife states that she called 911 after finding her husband lying in the bedroom unresponsive. She says he has a history of hypertension, for which hes taking chlorothiazide (a thiazide diuretic), and hyperlipidemia, which he controls with atorvastatin. Two days ago, he finished a 5-day course of antibiotics prescribed for bronchitis. She also says her husband has been drinking fluidsand urinatingmore frequently than usual. STAT laboratory tests show a plasma glucose level of 1,050 mg/dl, plasma osmolarity above 320 mOsm/kg, serum sodium level below 120 mEq/L, serum potassium level of 4.0 mEq/l, arterial pH 7.45, and a white blood cell (WBC) count of 30,000/mm3. Plasma ketones are absent. Although Mrs. Suarez says her husband has never been diagnosed with diabetes mellitus, his extremely high blood glucose level certainly suggests he has diabetes. Based on his other assessment findings, youd be correct to assume hes experiencing an acute complication of diabetes. But which one? Serious acute complications of diabetes include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Untreated, both can lead to death. However, their exact causes, clinical pr Continue reading >>

Management Of Diabetic Ketoacidosis In Adults

Management Of Diabetic Ketoacidosis In Adults

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 >>

Diabetic Ketoacidosis: Implications For The Medical-surgical Nurse.

Diabetic Ketoacidosis: Implications For The Medical-surgical Nurse.

Abstract Diabetic ketoacidosis (DKA) is an acute complication associated with type 1 diabetes mellitus. DKA accounts for a significant portion of annual health care expenditures and is considered a medical emergency. Previously treated in the ICU, DKA is now treated on general medical-surgical nursing units. To manage this crisis successfully, medical-surgical nurses must have a comprehensive knowledge and understanding of the pathophysiologic mechanisms, clinical manifestations, and treatment protocols. A critical pathway is presented to guide clinical care. Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Course Summary Diabetic ketoacidosis is an acute complication of diabetes mellitus, which requires prompt, aggressive, treatment. Complications of diabetic ketoacidosis throughout the age spectrum and during pregnancy require a close evaluation of symptoms, testing, treatment and outcomes to treatment. Anyone with diabetes, regardless of age or gender, can develop ketoacidosis. Guidelines exist that guide diabetes health teams and clinical care of the diabetic patient. Appropriate and timely treatment can reduce diabetic ketoacidosis complications and patients can recover to full health. Course Format Homestudy Course Syllabus Introduction Epidemiology Glucose, Insulin, And Diabetes: A Brief Review Glucose and Energy Type 1 and Type 2 Diabetes Classification System: Out of Date? Pathophysiology Of DKA - Pathophysiology, Signs and Symptoms of DKA Precipitating Causes Of DKA Clinical Signs And Symptoms Of DKA Diagnosis Of DKA Laboratory Tests Hyperkalemia Hyponatremia Other Electrolytes Amylase and Lipase Hepatic Transaminases Leukocytosis Serum Osmolality Renal Function Studies Troponin Levels Euglycemic DKA Gestational Diabetes And DKA Atypical Antipsychotics And DKA Complications Of DKA - Children, DKA and Cerebral Edema XI. Treatment For Diabetic Ketoacidosis Laboratory Tests Fluid Replacement Electrolyte Imbalances Insulin Therapy Acid-Base Disturbances and Bicarbonate Therapy Continuing Care and Monitoring for Complications Treatment Of Cerebral Edema Clinical Care, Prevention and Education Poor Access to Medical Care Lack of Information Emotional Acceptance and Non-compliance Summary Continue reading >>

Diabetic Ketoacidosis Nclex Review

Diabetic Ketoacidosis Nclex Review

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. 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. Glucose: fuels the cells so it can function. However, with DKA there is no insulin present to take the glucose into the cellso 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 isnt receiving enough insulinso 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 doesnt 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 hyperglycemic. Ketones: a byproduct of fat break down. In DKA, the body needs FUEL to function so it starts to break down FATS since it cannot use the glucose in the body. The patient will experience increased ketones in the body which are LIFE-THREATEN Continue reading >>

Diabetic Ketoacidosistreatment & Management

Diabetic Ketoacidosistreatment & Management

Diabetic KetoacidosisTreatment & Management Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... 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 fluid loss with intravenous fluids Correction of electrolyte disturbances, particularly potassium loss Treatment of concurrent infection, if present It is essential to maintain extreme vigilance for any concomitant process, such as infection, cerebrovascular accident, myocardial infarction, sepsis, or deep venous thrombosis . It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. This always should be followed by gradual correction of hyperglycemia and 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. Patients usually are not discharged from the hospital unless they have been able to switch back to their daily insulin regimen without a recurrence of ketosis. When the condition is stable, pH exceeds 7.3, and bicarbonate is greater than 18 mEq/L, the patient is allowed to eat a meal preceded by a subcutaneous (SC) dose of regular insulin. Insulin infusion can be discontinued 30 minutes later. If the patient is still nauseated and cannot eat, dextrose infusion should be continued and regular or ultrashort-acting insulin should be administered SC every 4 hours, according to blood glucose level, while trying to maintain blood glucose values at 100-180 mg/dL. The 2011 JBDS guideline recommends the Continue reading >>

Diagnosis

Diagnosis

Print If your doctor suspects diabetic ketoacidosis, he or she will do a physical exam and various blood tests. 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 >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

Emergency Treatment For Diabetes

Emergency Treatment For Diabetes

If not treated quickly enough, fluctuations in blood glucose levels can lead to a person with diabetes becoming unwell and losing consciousness. The two conditions associated with diabetes are: hyperglycaemia - high blood glucose hypoglycaemia - low blood glucose. The more common emergency is hypoglycaemia which affects brain function and can lead to unconsciousness if untreated. Diabetic ketoacidosis (DKA) is a life threatening complication in patients with untreated diabetes or improperly managed diabetes. It is most common among type 1, but it can also occur in type 2 if the body becomes physiologically stressed, for example during an infection. View the following table to see a comparison of the signs and symptoms of hyperglycaemia and hypoglycaemia in both type 1 and type 2 diabetes. Hypoglycaemia (low blood sugar) Hypoglycaemia occurs when any insulin in the body has moved too much glucose out of the bloodstream and blood glucose levels have become very low (less than 4 mmol/l). This is usually because the patient has taken too much insulin, exercised too vigorously or consumed alcohol on an empty stomach. This is commonly called a 'hypo'. Usually hypoglycaemia can be corrected simply by eating or drinking something with a high glucose content. If hypoglycaemia is not corrected, it can progress to more advanced symptoms such as slurred speech, confusion and ultimately unconsciousness. If a person loses consciousness they will need to have an emergency injection of a hormone called glucagon to raise the level of glucose in their blood. Some people with diabetes are at particular risk of hypoglycaemia: those who frequently experience hypoglycaemia, even if they are able to treat themselves people who have poor awareness of hypoglycaemia symptoms people who fast (e.g Continue reading >>

Diabetes - Early Treatment Essential In Dka

Diabetes - Early Treatment Essential In Dka

Diabetic ketoacidosis is a life threatening complication of diabetes mellitus that requires urgent treatment, writes David Chaney Diabetic ketoacidosis (DKA) is a serious, life-threatening metabolic complication of diabetes mellitus, which, whilst most common in type 1 diabetes mellitus, can on rare occasions present in patients with type 2 diabetes mellitus.1,2 DKA develops in those patients with either an absolute deficiency of insulin or a relative lack of insulin brought about by an excess of counter regulatory hormones. Prevalence of DKA Despite improved treatment strategies, DKA has an estimated death rate of 28 per 100, 000 patients with diabetes in the UK.3 Unfortunately there does not appear to be any reported statistics for deaths due to DKA within Ireland. In view of the nature of this condition most deaths occur in those aged under 45 years with some authors proposing DKA, as the most common cause of death in all diabetics under the age of 20 years.4 Given these statistics, it is imperative that nurses who are presented with this condition act promptly to ensure treatment is instigated immediately to guarantee best possible outcome for the patient. Precipitating factors One of the most important aspects of care of the patient with DKA is isolation of trigger factors associated with the condition. Research has repeatedly demonstrated infection as the most common precipitating factor in DKA,5,6 with factors such as missed insulin dose, new onset of diabetes and drugs and alcohol also identified.7 Whilst it must be acknowledged that it is not always possible to identify a cause for DKA, a full investigation is warranted if further episodes are to be avoided. DKA diagnosis and symptoms Diagnosis of DKA z Blood Glucose >12 mmol/l9 Presence of ketonuria9, or posit Continue reading >>

Sickly Sweet: Understanding Diabetic Ketoacidosis

Sickly Sweet: Understanding Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life threatening condition that can occur to people with diabetes. It is observed primarily in people with type 1 diabetes (insulin dependent), but it can occur in type 2 diabetes (non-insulin dependent) under certain circumstances. The reason for why it is not often seen in people with type 2 diabetes is because their body is still able to produce insulin, so the pathophysiology explained in the flowchart below is not as dramatic as compared to people with type 1 diabetes who do not make any insulin at all. There are various symptoms associated with DKA including: Hyperglycaemia Polyphagia (increased appetite and hunger) Polydipsia (increased thirst) Polyuria (increased urination) Glycosuria (glucose in the urine) Ketonuria (ketones in urine) Ketones in blood Sweet, fruity breath Tachypnoea leading to Kussmaul breathing (deep and laboured breathing pattern) The body tries to compensate for the ketone bodies (acid) by eliminating carbon dioxide (also an acid) thereby attempting to make the body more alkalotic to normalise the pH The compensation between the metabolic and respiratory system can be read about in this article Decreased bicarbonate The body tries to use the available bicarbonate (base) to buffer the ketone bodies (acid) in order to improve the metabolic ketoacidosis This actually worsens the situation the lower the bicarbonate becomes with a continual production of ketones Increased drowsiness/decreased level of consciousness As the pH decreases and becomes more acidotic, it has a direct effect on decreasing the level of consciousness in a person Increased urea Electrolyte disturbances Tachycardia and other cardiac arrhythmias Tachycardia is often a compensatory mechanism for the hypotension Cardiac arrhythmias a Continue reading >>

Diabetic Ketoacidosis Is An Under-appreciated Danger Facing Many Nursing Home Patients

Diabetic Ketoacidosis Is An Under-appreciated Danger Facing Many Nursing Home Patients

Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients Diabetes is a serious illness affecting many nursing home residents. Diabetics face an increased risk for a variety of health problems and complications, including ketoacidosis. Diabetic ketoacidosis is a dangerous complication of diabetes that occurs when you dont have enough insulin in your body. This serious complication is more common in people who have type 1 diabetes, rather than type 2 diabetes. Diabetic ketoacidosis develops when you have too little insulin in your body, raising your blood sugar level. This causes your body to break down fat for energy, creating toxic acids known as ketones. If left untreated, this can cause you to lose consciousness and even result in death. Symptoms develop quickly and include: Doctors can test for high blood sugar level and high ketone level in your urine in order to confirm ketoacidosis. Ketoacidosis is commonly triggered by an illness or a problem with insulin therapy. Elderly diabetic nursing home residents are more susceptible to infection and other illnesses, which in turn puts them at greater risk for developing ketoacidosis. However, the risk of ketoacidosis is highest if you are age 19 or younger and suffering from type 1 diabetes. Other possible triggers include: stress, physical or emotional trauma, high fever, surgery, heart attack, stroke, and alcohol or drug abuse. Treatment of ketoacidosis is done with fluid replacement, electrolyte replacement, and insulin therapy. These very treatments that are used to correct ketoacidosis are also the source of most ketoacidosis complications. These complications include: low blood sugar ( hypoglycemia ), low potassium ( hypokalemia ), and swelling of the brain (cerebral edema). The best w Continue reading >>

Understanding Diabetic Ketoacidosis

Understanding Diabetic Ketoacidosis

Dr. Roger Seheult gives a clear explanation with drawings of diabetic ketoacidosis, which accounts for 135,000 hospital admissions every year in the United States. What is diabetic ketoacidosis? What do you test the patient’s blood for? Is creatinine value increased or decreased in a patient with DKA? Is the glucose level increased or decreased in a patient with DKA? In less than 15 minutes, get the answers and never be confused about diabetic ketoacidosis again. Continue reading >>

Mind The Gap: A Nurses' Map To Understanding And Managing Dka

Mind The Gap: A Nurses' Map To Understanding And Managing Dka

Sep 26, 2014 ... Clinical Nurse Specialist. Cleveland Clinic Respiratory ... will be able to describe the physiology of DKA ... Diabetes. Usually associated with: Type II Diabetes. DKA results from an .... In Current Medical Diagnosis &. Treatment. Mind the Gap: Navigating the Underground World of DKA Christina Canfield, MSN, RN, ACNS-BC, CCRN Clinical Nurse Specialist Cleveland Clinic Respiratory Institute Objectives • Upon completion of this activity the learner will be able to describe the physiology of DKA • Upon completion of this activity the learner will be able to describe the nurse’s role in treatment strategies for DKA Back That Train Up! • Insulin has a number of effects on glucose metabolism, including: – Inhibition of glycogenolysis and gluconeogenesis • Insulin hits the breaks on extra glucose conversion or production – Increased glucose transport into fat and muscle • Insulin takes glucose on a sweet ride into the fat and muscle – Increased glycolysis in fat and muscle • Insulin fuels the generation of ATP – Stimulation of glycogen synthesis • Insulin parks the glucose train at the station until it’s needed 1 9/26/2014 So what causes DKA? How do you know you’re on the right train? Diabetic Keto Acidosis Type I Diabetes DKA results from an insulin deficiency; in response the body switches to burning fatty acids and producing acidic ketone bodies Hyperosmolar Hyperglycemic State Usually associated Type II Diabetes with: >250 Plasma glucose (mg/dL) >600 7.3 18 + Urine Ketones Small + Serum Ketones < 0.6mmol/L Variable Serum Osmolality >10-12 Anion Gap >320 HHS results from an insulin deficiency that leads to a serum glucose that is usually higher 600 mg/dl, and a resulting high serum osmolality Variable Insulin deficiency PHYSIOLO Continue reading >>

Management Of Adult Diabetic Ketoacidosis

Management Of Adult Diabetic Ketoacidosis

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 >>

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