DKA is a life-threatening condition that develops when cells in the body are unable to get the glucose they need for energy because deficiency of the insulin. Without enough insulin, the body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

1. CASE PRESENTATION
ON
DIABETIC KETOACIDOSIS
Presented by
MAKBUL HUSSAIN CHOWDHURY
H.T. No.15Z11T0006
Pharm. D 4th year
Anurag Pharmacy College, Kodad

2. WHAT IS THE DIABETIC KETOACIDOSIS ( DKA ) ?
 DKA is a life-threatening condition that develops when cells in
the body are unable to get the glucose they need for energy
because deficiency of the insulin.
 Without enough insulin, the body begins to break down fat as
fuel.
 This process produces a buildup of acids in the bloodstream
called ketones, eventually leading to diabetic ketoacidosis if
untreated.

3. CAUSES :
 Severe infection or other illness, leading to severely dehydration
due to decrease of the insulin levels.
 It can occur in people who have little or no insulin in their bodies
(Diabetes type 1).
 When the blood sugar levels are high (diabetes type 2)

4. Sings and symptoms
 Frequent urination.
 Extreme thirst.
 High blood sugar levels.
 High levels of ketones in the urine.
 Nausea or vomiting.
 Abdominal pain.
 Confusion.
 Fruity-smelling breath.

5. PATHOPHYSIOLOGY

6. DIAGNOSIS
 Notice symptoms such as : ( Drowsiness , rapid breathing ,fruity
breath odor ,loss of appetite, belly pain .. )
 Laboratory tests, including blood and urine tests, are used to
confirm a diagnosis of diabetic ketoacidosis.
 High blood glucose level.
 Glucose and Ketones body in Urine.
 Acidosis (Ph low than 7.30)

7. CASE STUDY
CHIEF COMPLAIN:
xxx is a 37 years old female, come to the hospital complaining of
abdominal pain, shortness of breath, chest pain and palpitation.
HISTORY OF PRESENT ILLNESS:
She has had 2 times Gestational diabetes 4 years ago in her first
pregnant and 1 years ago in her second pregnant.
Family history : Unknown.
Allergy : No Kind of Allergy.
Medication history : did not mention.

8. REVIEW OF SYSTEMS :
 Eyes: normal
 Mental status: conscious.
 Respiratory system: Normal sounds
 Cardiovascular system: S1+S2
 Chest wall & breast: No any diseases
 Abdomen: soft and lax.
 Extremities : No any diseases

9. VITAL SIGNS
Temperature: 37.3° C
PR: 160 bpm (high),
RR: 40 bpm
Oxygen saturation: 98%
BP: 135/80 mmHg(high)

10. CBC
Content Value Normal Value
WBC 12.06x10^9/L 4-10 x10^9/L
RBC 5.5X10^12/L 4.5 -5.5 X10^12/L
Hb 14g/dL 12-16g/dL

11. URINE ANALYSIS
Content Value Normal Value
Glucose 417mg/dl 70-119mg/dl
K 4.99 3.5-5.3
Na 136 135-153
Cl 99 98-110

12. FINAL DIAGNOSIS:
DIABETIC KETOACIDOSIS

13. TREATMENT
Name Brand Name Dose Frequenc
y
ROA Day of
administratio
n
Dextrose Solution
+ NS(electrolyte
replenishment)
Dextrose
Normal Saline
250 mg Q 1 hr IV 1nd -4th day
Regular Insulin Insulin 7 IU Q 1 hr IV 1st day -6th day
Propranolol (beta
blocker)
Anaprilin 10 mg TID P.O 2nd day -4th
day
Ceftriaxone(antibi
otics)
Rocephin 1 g BID IV 1st day-3rd day
Enoxaparine
(blood thinner)
Lovenox
4000 IU OD SC 2nd day , 4th
day
Omeprazole(prot
on pump
inhibitors
Omesec 40 mg OD IV 2nd day- 6th
day
Insulin Glulisine Insulin Glulisine 1 mEQ TID S.C 1st day -6th day
Ventoline(wheezi
ng & SOB)
salbutamol 100 mpg BID 2 puffs 2nd – 4th day

14. PATIENT COUNSELING
About disease : It happen when the body has high level of blood
sugar(glucose) built up of acids.
Non pharmacological treatment
a. Never skip Insulin Dose.
b. Having small diet rather than large diet at once.
c. Maintain diet rich in fiber and less in carbohydrate.
d. Regular test for insulin and ketone bodies.
e. Avoid eating chocolate.
f. If you’re unable to eat full meals, ensure you eat snacks or drink
fluids containing glucose, along with plenty of water or sugar-
free fluids (four to six pints per day).

15. PATIENT COUNSELING
Pharmacological treatment:
 Insulin: It work by helping blood sugar (glucose) gets in to
cells so that the body can use it for energy ,it is always given
by subcutaneous route.
 Do not stop taking your insulin under any circumstances.
 Be confident in adjusting insulin doses during illness. Always
seek advice quickly if you are unsure.
 Ensure insulin is stored correctly to stop it getting damaged and
make sure insulin pens, needles and personal infusion pumps
are working properly.

16.  Make sure you have a personal supply of ketone testing
equipment (available from your GP or diabetes team).
 Always keep well hydrated. Water is best, try to avoid too many
caffeinated drinks such as tea, coffee and fizzy drinks.
 Ensure you keep up to date with your personal diabetes education
as much as possible. Your GP or diabetes team will be able to
help you with this.
 It’s very important to follow the instructions you have been given
to care for and maintain your devices to keep them working
effectively and safely. If you use a pump, remember to change
your tubing/ cannula every two to three days or as advised by
your diabetes team

17.  If you feel unwell or have symptoms of high blood glucose, check
your glucose and ketone levels straight away. Seek medical advice
quickly if you’re feeling unwell and are at all concerned about your
blood glucose or ketone levels.