Read Also: Diabetes Mellitus
A complication of diabetes mellitus characterized by hyperglycemia and a hyperosmolar state without ketosis. It often occurs in Type 2 Diabetics.
- Precipitation Factors: Undiagnosed diabetes, infections, major burns, other stressors, medications (Dilantin, Thiazide diuretics), dialysis, hyperalimentation, pancreatic disease
Assessment Findings
Similar to asssessment findings for ketoacidosis but without Kussmaul’s Respirations and Acetone Breath, both of which are caused by ketonemia.
Assessment
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- 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 Examinations
- Blood Glucose is extremely elevated; glycosuria
- BUN, Creatinine, and Hct are elevated due to dehydration
Management
Similar to management for ketoacidosis but without treatment for ketosis and metabolic acidosis
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.
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