What signs and symptoms would the nurse assess for in a patient with DKA?

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.

Don’t forget to take the DKA Quiz.

In these notes you will learn about:

• Key Player of DKA
• Causes of DKA
• Signs and Symptoms of DKA
• Nursing Interventions of DKA

Lecture on Diabetic Ketoacidosis

Diabetic Ketoacidosis

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.

Key Players of DKA:

Glucose: fuels the cells so it can function.  However, with DKA there is no insulin present to take the glucose into the cell…so 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 isn’t receiving enough insulin…so 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 doesn’t 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-THREATENING to a diabetic patient because it causes the blood to become acidic (metabolic acidosis)

Kidneys: plays a role in reabsorbing glucose in the renal tubules. However, there is too much glucose present in the blood and it cannot be reabsorbed.  So,  it leaks into the urine and this causes OSMOTIC DIURESIS which causes polyuria and excretion of electrolytes (sodium,potassium, chloride)

Happens mainly in TYPE 1 Diabetics…rare in type 2 but possible if they are experiencing a severe illness.

Causes of DKA

• Undetected diabetes: patient doesn’t know they are diabetic and this is the first sign, usually.
• More Insulin needed by the body than normal: the body needs more units of insulin than it is actually receiving from injections.
  • Example: when a diabetic become sick (INFECTION) with illness or recovering from surgery or experiences some type of stress on the body like certain drugs such as, corticosteroids or thiazide diuretics.
• Not eating (skipping meals): body starts to go into “starvation” mode and begins to burn ketones (normally in nondiabetics when the body goes into starvation mode it can cope when ketones are released by regulating insulin and glucagon to maintain sugar levels…but in the diabetic they don’t have that ability and ketones production is dangerous).
• Not taking insulin as scheduled: therefore the blood glucose levels are not controlled…ketones are produced and the cycle of acidosis starts to take place in the body.

Signs & Symptoms of Diabetic Ketoacidosis:

Recap of what is going on:

• Hyperglycemia (intracellular to extracellular shifting takes place which will lead to electrolyte imbalances)
• Ketones in the blood (leads to metabolic acidosis, weight loss because of all the fat burning, electrolyte shifting as well)
• Metabolic Acidosis (blood pH <7.35 and HCO3 <15 mEq/L)

Happens suddenly (there may be warning signs present if the patient is monitoring their blood glucose which will be elevated consistently (>300 mg/dL)

• Polyuria: due to the extreme levels of glucose in the body that causes the water inside the cells to shift to the extracellular area. The kidneys try to compensate by increasing urinary production to eliminate this extra fluid but the kidneys cannot reabsorb all the glucose so it leaks into the urine. This causes OSMOTIC DIURESIS which causes SODIUM AND POTASSIUM (along with calcium, phos) TO BE EXCRETED.

*NOTE potassium levels typically stay normal or elevated in DKA because of the shifting of potassium from the inside of the cell to the outside BUT WHEN TREATMENT STARTS TO BE INITATED WITH INSULIN IT WILL CAUSES THE K+ TO MOVE BACK INTO THE CELL. Therefore, you have to watch POTASSIUM LEVELS closely during treatment.

Which symptoms may be observed in patients with DKA?

What is the priority assessment for DKA?

Which findings are associated with DKA?

Which of the following is the most common early symptom of DKA?