Diabetic ketoacidosis is a serious condition caused by insufficient insulin that prevents glucose from entering cells, resulting in hyperglycemia, polyuria, and polydipsia. It is diagnosed when blood glucose is over 250 mg/dL, blood pH is below 7.35, and bicarbonate is below 15 mEq/L. Nursing management involves three phases: assessment, management, and monitoring. Management in the first 24-48 hours focuses on fluid resuscitation and insulin therapy to correct electrolyte imbalances and lower blood glucose while closely monitoring vital signs and lab values.

2. DEFINITION
Diabetic keto-acidosis is a serious condition in which body
has insufficient insulin to allow enough glucose to enter
cells cause lipolysis. Specially occur type 1 diabetes Result
in hyperglycemia + polyuria + polydipsia
CRITERIA OF KETOACIDOSIS
WHEN
Glucose is > 250 mg/dl
Blood pH < 7.35
HCO3 < 15mEq/L

5. Nursing management
It divided into 3 phases
 PRE = Assessment phase
 INTRA = Management phase
 POST= Monitoring phase

6. Assessment phase
 Assessment of –
 Skin :- skin integrity, diaphoresis, eye reflex
 Vital sign – respiration, heart rate, temperature, BP
 Mental status- confused , orientation level , conscious level
 Urine analysis- urine output

7. Management

8. First 24 hours
1. Managing diabetic ketoacidosis (DKA) in an intensive
care unit during the first 24-48 hours always is advisable.
 Correction of fluid loss
 Administer 1-3 L fluid in first hours
 Administer 1 L liter in second hours
 Administer 1 L fluid in following 2hours
 Administer 1L every 4hours, depending on the degree of
dehydration

9. Fluid can be use
1. 09% Normal saline
2. 0.45% normal saline
3. Dextrose 5%

10. Insulin therapy
1. Short acting insulin
2. IV infusion 50 IU insulin + in 50 ml NS
3. SC insulin after 2hr when blood glucose is below 250
mg/dl

11. Potassium therapy
 Normal K level :- 3.5 - 5.0
 Potassium correction :- 20-40 mEq/L
 If serum K level is <3.3 mEq/L. Do not administer insulin
until K corrected

12. Monitoring phase
Monitor
 Vital sign
 Input/ output
 Physical assessment
 Blood values – pH, K, Na , HCO3, glucose
 Repeat urine analysis for ketones & glucose
 Mental stats after therapy
 Change position is very important
 Educate patient & family member about cause of these event
 Educate family member about diet & regular insulin at home
 Recording all the event of the patient mention above

15. Research study
Clinical Profile of Diabetic Ketoacidosis: A Prospective
Study in a Tertiary Care Hospital
Sample :- 60
Setting :- Kasturba medical college, Manipal
Karnataka, India
Result:-
1. Most common symptoms 60.33 % was nausea &
vomiting
2. Common cause about 73.33% was infection
3. Fluid requirement on first day is 3.15 Liters. Thus
mortality of 10% was seen
Conclusion :- Diabetic ketoacidosis is a fatal acute metabolic complication
of Diabetes Mellitus with heterogeneous clinical presentation. Early
diagnosis and treatment can avoid morbidity & mortality.

16. 1. Write the nursing care of patient with diabetic foot &
meal plan
Date of submission :- 18-07-2018