This deficiency in available insulin results in disorders in the metabolism of carbohydrate, fat, and protein. Feb 02, 2014 diagnostic criteria for dka dka mild plasma glucose mgdl ph anion gap bicarbonate meql urine ketones serum ketones effective serum osmol mosmkg alteration in sensoria or mental obtundation moderate severe 250 7. A major difference between adults with dka and children with dka is that children are particularly at risk for cerebral edema ce, which is extremely rare in adults. To help clinicians early identify signs and symptoms of diabetic ketoacidosis. Pathophysiology diabetic ketoacidosis is a serious complication of diabetes mellitus that occurs when uncontrolled blood sugar rises and the body cant produce enough insulin to use the glucose. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. Dka and hhs remain important causes of morbidity and mortality among. Descriptionetiology lesson quick diabetic ketoacidosis in. While the incidence of dka is difficult to establish, populationbased studies suggest an annual incidence of 4.
When this happens, the body begins to break down fat as energy which produces a buildup of acid in the bloodstream called ketones. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. Diabetic ketoacidosis dka a condition brought on by inadequate insulin is a lifethreatening emergency usually affecting people with type 1 diabetes. Over the past 20 years, mortality rates in developed countries have fallen from 7. Medical surgical nursing diabetes mellitus lecture 3 the. Diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria.
Helen ballestas, phd, rn, crrn is an assistant professor at the adelphi school of nursing, where she teaches pathophysiology and medicalsurgical nursing. Diabetic ketoacidosis dka nursing dka pathophysiology. Following the publication of the pekarn dka fluid trial new engl j med 2018. Diabetic ketoacidosis and hyperglycemic hyperosmolar state.
The free fatty acids are converted into ketone bodies by the liver. Evidencebased management of hyperglycemic emergencies in. Results for dka pathophysiology 1 10 of 37 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Pathophysiology of diabetic ketoacidosis diabetes library. Diagnostic criteria for dka dka mild plasma glucose mgdl ph anion gap bicarbonate meql urine ketones serum ketones effective serum osmol mosmkg alteration in sensoria or mental obtundation moderate severe 250 7.
One of the most severe complications of diabetes, diabetic ketoacidosis dka, results from insulin deficiency and is a medical emergency that is frequently encountered in the emergency department. Diabetic ketoacidosis introduction diabetic ketoacidosis dka is a very serious complication of diabetes mellitus, a metabolic disorder that is characterized by hyperglycemia, metabolic acidosis, and increased body ketone concentrations. Dka is the first manifestation of type 1 dm in a minority of patients. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are. Pathophysiology of diabetic ketoacidosis the patient experiencing dka presents significantly different from one who is hypoglycemic. Dka usually occurs as a consequence of absolute or relative insulin deficiency that. Those are the basics of the pathophysiology and complications of diabetes.
Insulin deficiency, increased insulin counterregulatory hormones cortisol, glucagon, growth hormone, and catecholamines and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance which. Diabetic ketoacidosis dka is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the bodys basic metabolic requirements. However, the child differs from the adult in a number of characteristics. Definition classification pathophysiology clinical manifestations treatment complications diabetic ketoacidosis dka is the end result of the metabolic. Management of diabetic ketoacidosis in adults nursing times.
The majority of patients presenting with dka are under the age of 19. Student trying to understand dka and dehydration nursing. Apr 12, 2019 diabetic ketoacidosis dka is a lifethreatening emergency caused by a relative or absolute deficiency of insulin. This paper will summarize and evaluate two articles that discuss diabetic ketoacidosis dka treatment protocols and the management of dka. Diabetic ketoacidosis dka is a common, serious, and preventable complication of type 1 diabetes, with a mortality of 35%. I understand that there is an increase of glucose in the urine, and an increase in urine production, so obviously the need to urinate is substantial. Pathophysiology diabetic ketoacidosis dka is a complex disordered metabolic state characterised by hyperglycaemia, acidosis, and ketonaemia. The patient with dka may have altered level of consciousness, polydipsia, polyuria, abdominal pain, nausea and vomiting, and a. Elsevier is a leading publisher of health science books and journals, helping to advance medicine by delivering superior education, reference information and decision support tools to doctors, nurses, health practitioners and students. Diabetic ketoacidosis dka is a lifethreatening emergency caused by a relative or absolute deficiency of insulin.
The evidence for the role of preventive measures in dka and hhs is also discussed. This is due to the variation in the pathology of the condition. The adage a child is not a miniature adult is most appropriate when considering diabetic ketoacidosis dka. A succinct discussion of the pathophysiology and important etiological factors in dka and hhs are provided as a prerequisite for understanding the rationale for the effective therapeutic maneuvers employed in these acute severe metabolic conditions.
More commonly seen in patients with type 1 diabetes t1d, dka results when lipid breakdown generates a surplus of acidic. Dka is a complication of diabetes mellitus and mainly affects type 1 diabetics. A challenging diagnosis requiring rapid interventions, dka is characterized by hyperglycemia, glycosuria, dehydration, electrolyte imbalance, acidosis, and ketonuria. Jan 17, 2011 ok, im trying to understand the underlying pathophysiology behind why dehydration happens with dka patients. Diabetic ketoacidosis is a potentially lifethreatening complication of diabetes, making it a medical emergency. Make sure you check out the rest of this module to learn about nursing care, as well as dka, and hhns. Poor patient education is probably the most important determinant of the incidence of the catastrophe that constitutes dka. Diabetic ketoacidosis management in adults nursing times. May 31, 2019 diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Pathophysiology of disease 7th edition pdf medicine book.
She has written extensively, and has contributed to a number of quality books, including the incredibly easy series, straight as, and lwws nursing series. The most common causes of dka are infection and poor compliance with medication regimens. Diabetic ketoacidosis and hyperglycemic hyperosmolar state asped. Diabetes, a chronic medical condition, continues to increase in prevalence.
In several series, only about a fifth of patients with dka are firsttime presenters with recently acquired type i diabetes mellitus. Diabetic ketoacidosis international society for pediatric and. It occurs when absolute or relative insulin deficiency inhibits the ability of glucose to enter cells for utilization as metabolic fuel, the result being that the liver rapidly breaks down fat into ketones to employ as a fuel source. Pathophysiology of diabetic ketoacidosis diabetic ketoacidosis is one of the potentially lifethreatening acute complications of diabetes mellitus. Pathophysiology and treatment diabetic ketoacidosis dka, also known as diabetic acidosis or diabetic coma, is a severe complication of diabetes mellitus dm. According to gosmanov 2014, the diagnostic criteria for dka includes blood glucose greater than 250mgdl, arterial ph less than 7. Introduction diabetic ketoacidosis dka is an acute, major, lifethreatening complication of diabetes. Dka usually occurs as a consequence of absolute or relative insulin deficiency that is accompanied by an increase in counter. The patient with dka may have altered level of consciousness, polydipsia, polyuria, abdominal pain, nausea and vomiting, and a fruity or acetone breath odor. Nursing care plan for diabetic ketoacidosis dka nrsng. Pdf diabetic ketoacidosis dka, resulting from severe insulin deficiency, accounts for.
Dka is usually signaled by high blood sugar levels. Diabetic ketoacidosis dka and the hyperglycemic hyperosmolar state hhs are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. It can also occur in patients with other types of diabetes. The fundamental pathophysiology of this potentially lifethreatening complication is the same as in adults. Click through for an easy breakdown of the pathophysiology of diabetic ketoacidosis otherwise known as dka to help you in your medical surgical nursing class. Main clinical features of dka are hyperglycemia, acidosis, dehydration, and electrolyte losses such as hypokalemia. To provide information about diabetic ketoacidosis dka in adults, including risk. Diabetic ketoacidosis in infants, children, and adolescents. Insulin deficiency, increased insulin counterregulatory hormones cortisol, glucagon, growth hormone, and catecholamines and peripheral insulin resistance lead to hyperglycemia, dehydration, ketosis, and electrolyte imbalance which underlie the pathophysiology of dka.
Another effect is breakdown of fat into free fatty acids and glycerol. Pathophysiology of disease 7th edition pdf for free. The management of diabetic ketoacidosis in children. Dehydration may be great in diabetic ketoacidosis, and intravenous fluids are usually needed as part of its. Ok, im trying to understand the underlying pathophysiology behind why dehydration happens with dka patients. In the past, diabetic ketoacidosis was considered as the hallmark of type i diabetes, but current data show that it can be also diagnosed in patients with type ii diabetes mellitus. It also occurs in type 2 diabetes under conditions of extreme stress such as serious infection, trauma, cardiovascular or other emergencies, and, less often, as a presenting manifestation of type 2 diabetes, a disorder called ketosisprone diabetes mellitus. Nclex material, textbook chapters, and more than 100 online ce articles, and done. If youre struggling with diabetic ketoacidosis dka, med surg, the endocrine system, or pathophysiology in nursing school, than youll. Insulin deficiency can be absolute eg, during lapses in the administration of. Experienced nursing staff trained in monitoring and management of. Treatment includes insulin and glucose administration, fluidelectrolyte. Management of diabetic ketoacidosis article nursingcenter.
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