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•
Diabetic ketoacidosis
•
Introduction of Diabetic Ketoacidosis
•
Ms. C.C. Mariano & Mr. M.J. De Guzman
•
Introduction:
•
Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes.
•
It occurs when the body starts breaking down fat at a rate that is much too fast.
•
The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.
•
Causes:
DKA happens when the signal from insulin in the body is so low that: •
Glucose (blood sugar) can't go into cells to be used as a fuel source.
•
The liver makes a huge amount of blood sugar.
•
Fat is broken down too rapidly for the body to process.
•
The fat is broken down by the liver into a fuel called ketones.
•
Ketones are normally produced when the body breaks down fat after a long time between meals.
•
When ketones are produced too quickly and build up in the blood and urine, they can be toxic by making the blood acidic. This condition is known as ketoacidosis.
•
DKA is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed.
•
It can also occur in someone who has already been diagnosed with type 1 diabetes.
•
Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes.
•
People with type 2 diabetes can also develop DKA, but it is less common and less severe. It is usually triggered by prolonged uncontrolled blood sugar, missing doses of medicines, or a severe illness or infection.
•
PreDISPOSING fACTORS
•
discontinuation of or inadequate insulin therapy,
•
pancreatitis,
•
myocardial infarction,
•
cerebrovascular accident,
•
and drugs
•
Clinical manifestation
•
Excessive thirst.
•
Frequent urination.
•
Nausea and vomiting.
•
Abdominal pain.
•
Weakness or fatigue.
•
Shortness of breath.
•
Fruity-scented breath.
•
Confusion.
•
Anatomy, physiology and pathology; diagnostic procedures
•
Ms. K.J. Anulacion and Mr. A.D. Dumlao Anatomy
•
Pancreas The pancreas is about the size of the half of your hand that includes the index and third fingers excluding the thumb. The pancreas weighs about 100 grams and is 14-20 cm long
The head of the pancreas lies in the loop of the duodenum as it exits the stomach. • The tail of the pancreas lies near the hilum of the spleen. • The body of the pancreas lies posterior to the distal portion of the stomach between the tail and the neck and is unlabeled in this drawing. • The portion of the pancreas that lies anterior to the aorta is somewhat thinner than the adjacent portions of the head and body of the pancreas. This region is sometimes designated as the neck of the pancreas and marks the junction of the head and body. • The close proximity of the neck of the pancreas to major blood vessels posteriorly including the superior mesenteric artery, superior mesenteric-portal vein, inferior vena cava, and aorta limits the option for a wide surgical margin when pancreatectomy (surgical removal of the pancreas) is done. • The common bile duct passes through the head of the pancreas to join the main duct of the pancreas near the duodenum
Pancreatic Islets (Islet of Langerhans) Alpha Cells- Insulin Beta Cells- Glucagon Delta Cells-Somatostatin •
Urinalysis
•
U/a is unreliable as a marker for resolving of acidosis because ketone bodies can still be detected in urine long after ketoacidosis is resolved. Urine reflects changes over previous several hours, but not current state. Directly measured B-OHB is the preferred test for ketonaemia as B-OHB is the strongest and most prevalent acid in DKA
•
In the Result, Ketones and Glucose are present
•
DKA: Nursing Responsibilities & Mgt
•
Regular (atleast hourly) monitoring of V/S and LOC during the acute phase.
•
Accurate monitoring of fluid balance (I&O)
•
Insulin therapy as prescribed
•
Regular monitoring of capillary blood glucose & ketones
•
Provide psychological support
•
Provide education
•
DKA: Nursing Responsibilities & Mgt
•
Weigh client daily
•
Insert indwelling urinary catheter as indicated
•
Monitor BUN & Creatinine
•
TREATMENT
•
If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves:
•
Fluid replacement
•
You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood.
•
Electrolyte replacement
•
Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes through a vein to help keep your heart, muscles and nerve cells functioning normally.
•
Insulin therapy
•
Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein. When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.
Diabetic ketoacidosis
•
Introduction of Diabetic Ketoacidosis
•
Ms. C.C. Mariano & Mr. M.J. De Guzman
•
Introduction:
•
Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes.
•
It occurs when the body starts breaking down fat at a rate that is much too fast.
•
The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.
•
Causes:
DKA happens when the signal from insulin in the body is so low that: •
Glucose (blood sugar) can't go into cells to be used as a fuel source.
•
The liver makes a huge amount of blood sugar.
•
Fat is broken down too rapidly for the body to process.
•
The fat is broken down by the liver into a fuel called ketones.
•
Ketones are normally produced when the body breaks down fat after a long time between meals.
•
When ketones are produced too quickly and build up in the blood and urine, they can be toxic by making the blood acidic. This condition is known as ketoacidosis.
•
DKA is sometimes the first sign of type 1 diabetes in people who have not yet been diagnosed.
•
It can also occur in someone who has already been diagnosed with type 1 diabetes.
•
Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to DKA in people with type 1 diabetes.
•
People with type 2 diabetes can also develop DKA, but it is less common and less severe. It is usually triggered by prolonged uncontrolled blood sugar, missing doses of medicines, or a severe illness or infection.
•
PreDISPOSING fACTORS
•
discontinuation of or inadequate insulin therapy,
•
pancreatitis,
•
myocardial infarction,
•
cerebrovascular accident,
•
and drugs
•
Clinical manifestation
•
Excessive thirst.
•
Frequent urination.
•
Nausea and vomiting.
•
Abdominal pain.
•
Weakness or fatigue.
•
Shortness of breath.
•
Fruity-scented breath.
•
Confusion.
•
Anatomy, physiology and pathology; diagnostic procedures
•
Ms. K.J. Anulacion and Mr. A.D. Dumlao Anatomy
•
Pancreas The pancreas is about the size of the half of your hand that includes the index and third fingers excluding the thumb. The pancreas weighs about 100 grams and is 14-20 cm long
The head of the pancreas lies in the loop of the duodenum as it exits the stomach. • The tail of the pancreas lies near the hilum of the spleen. • The body of the pancreas lies posterior to the distal portion of the stomach between the tail and the neck and is unlabeled in this drawing. • The portion of the pancreas that lies anterior to the aorta is somewhat thinner than the adjacent portions of the head and body of the pancreas. This region is sometimes designated as the neck of the pancreas and marks the junction of the head and body. • The close proximity of the neck of the pancreas to major blood vessels posteriorly including the superior mesenteric artery, superior mesenteric-portal vein, inferior vena cava, and aorta limits the option for a wide surgical margin when pancreatectomy (surgical removal of the pancreas) is done. • The common bile duct passes through the head of the pancreas to join the main duct of the pancreas near the duodenum
Pancreatic Islets (Islet of Langerhans) Alpha Cells- Insulin Beta Cells- Glucagon Delta Cells-Somatostatin •
Urinalysis
•
U/a is unreliable as a marker for resolving of acidosis because ketone bodies can still be detected in urine long after ketoacidosis is resolved. Urine reflects changes over previous several hours, but not current state. Directly measured B-OHB is the preferred test for ketonaemia as B-OHB is the strongest and most prevalent acid in DKA
•
In the Result, Ketones and Glucose are present
•
DKA: Nursing Responsibilities & Mgt
•
Regular (atleast hourly) monitoring of V/S and LOC during the acute phase.
•
Accurate monitoring of fluid balance (I&O)
•
Insulin therapy as prescribed
•
Regular monitoring of capillary blood glucose & ketones
•
Provide psychological support
•
Provide education
•
DKA: Nursing Responsibilities & Mgt
•
Weigh client daily
•
Insert indwelling urinary catheter as indicated
•
Monitor BUN & Creatinine
•
TREATMENT
•
If you're diagnosed with diabetic ketoacidosis, you might be treated in the emergency room or admitted to the hospital. Treatment usually involves:
•
Fluid replacement
•
You'll receive fluids — either by mouth or through a vein (intravenously) — until you're rehydrated. The fluids will replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood.
•
Electrolyte replacement
•
Electrolytes are minerals in your blood that carry an electric charge, such as sodium, potassium and chloride. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes through a vein to help keep your heart, muscles and nerve cells functioning normally.
•
Insulin therapy
•
Insulin reverses the processes that cause diabetic ketoacidosis. In addition to fluids and electrolytes, you'll receive insulin therapy — usually through a vein. When your blood sugar level falls to about 200 mg/dL (11.1 mmol/L) and your blood is no longer acidic, you may be able to stop intravenous insulin therapy and resume your normal subcutaneous insulin therapy.
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