Read Also: Diabetes Mellitus
A state of metabolic acidosis resulting from compensatory lipolysis in patients with diabetes mellitus. It may be precipitated by neglect of treatment, infection, cardiovascular disorders, and other stressors.
Assessment
- Acute complication of DM results in hyperglycemia and ketonemia.
- Polyphagia, Polydipsia, Polyuria
- Nausea and Vomiting, Abdominal Pain
- Dry Mucous Membranes, Soft Eyeballs
- Kussmaul’s Breathing or Tachypnea, Acetone/Fruity Breath
- Altered Level of Consciousness (metabolic acidosis causes CNS depression), Hypotension
- Tachycardia
Diagnostic Examination
- Serum Glucose is elevated, up to 600 mg/dL.
- Serum Ketones are elevated, and Ketonuria is present.
- BUN, Creatinine, and Hematocrit are elevated due to dehydration.
- Na is decreased, K is elevated (due to acidosis)
- ABG: Metabolic Acidosis with Compensatory Respiratory Alkalosis
- Metabolic Acidosis compatible with Hyperkalemia
Management
- Establish and maintain a patent airway.
- Maintain F&E balance (fluid overload, hypokalemia, hyperkalemia)
- IV Therapy:
- 0.9NaCl, then 0.45NaCl
- If blood glucose drops to 250 mg/dL, D5W may be added.
- Potassium Chloride will be added once urine output is adequate.
- Insulin Therapy: Regular Insulin (IV drip or push; SC). If IV, add albumin because insulin adheres to IV tubing. Monitor blood glucose levels frequently.
- Health education for reasons for developing DKA and diabetic education if necessary.
Pathophysiology
flowchart TB
1(Cellular Starvation)-->2
2(Compensatory Lipolysis)-->3
3(Ketone Production\nKetonemia\nKetonuria)-->4
4(Metabolic Acidosis)