dka

1. YASH RAMAWAT M.N. FINAL

2.  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

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

4. How lack of insulin develop
acidosis

5. Insulin Deficiency
Glucose uptake
Proteolysis
Lipolysis
Amino Acids
Glycerol
Free Fatty Acids
Gluconeogenesis
Glycogenolysis
Hyperglycemia
Ketogenesis
Acidosis
Osmotic diuresis Dehydration
PATHOPHYSIOLOGY

6. 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

7. Counterregulatory Hormones - DKA
Increases
insulin
resistance
Activates
glycogenolysis
and
gluconeogenesis
Activates
lipolysis
Inhibits insulin
secretion
Epinephrin
e X X X X
Glucagon
X
Cortisol
X X
Growth
Hormone X X X

9. 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

10. Insuline
Intravenous route
Insulin regular 0.15 U/kg
b. Wt. As iv bolus
0.1 u/kg/hr Iv insulin
infusion
SC/IM route
Insulin 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

11. potassium
If serum K+ is < 3.3 mEq/l hold insulin and
give 40mEq k/hr until k+ >3.3
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

12. Assess
need for
bicarbonate
pH < 6.9
NaHco3( 100 mmol )
dilute in 400 ml water at
200ml/hr
pH .>7 pH6.9-7.0
NaHco3( 50 mmol ) dilute in
400 ml water at 200ml/hr
Repeat HCO3 administration q 2h
untill pH > 7.0.

13. 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

14. 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

15. • 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.

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