Dka 1

Prepared by:- Rania Hesham Ata.
Group 13
Under supervision:- Dr: Mahmoud Moresy.

*Outline:-
-Introduction
-pathophysiology
-definition
-causes
-Risk factors
-sign, symptoms
-Complications
-diagnosis
-prevention
-medical management
-nursing management
-References.
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. KA 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 the stress of Surgery can lead to DKA
in people with type 1 diabetes.
NB: People with type 2 diabetes can also develop DKA,

but it is less Common and less severe.
Definition
Diabetic ketoacidosis: It is a potentially life-threatening
complication in patients with Diabetes mellitus.
Occurring mostly in patients with type 1 diabetes, they
may occur In patients with type 2 diabetes under certain
circumstances.Results from a deficiency of insulin; In
response, the body moves
To burn fatty acids and produce acid ketone bodies,
which cause Most of the symptoms and complications.
• Pathophysiology
Diabetic ketoacidosis arises because of a lack of insulin
In the body that is accompanied by an increase in
Counter-regulatory hormones (i.e., glucagon, cortisol,
Growth hormone, epinephrine). This type of hormonal
Imbalance enhances lipolysis. Lipolysis increases serum
free fatty Acids . Ketones are normally produced by the
liver when the body breaks Down fat after it has been a
long time since your last meal. When ketones are
Produced too quickly and build up in the blood, they can
be toxic by making The blood acidic. This condition is
known as ketoacidosis. When the Accumulated ketones
exceed the body’s capacity to extract them, they
Overflow into urine (i.e., ketonuria), And acetone odor
breath. If the situation Is not treated promptly, a greater
accumulation of organic acids leads to Frank clinical
metabolic acidosis (i.e., ketoacidosis), with a significant
drop In pH and bicarbonate serum levels. Respiratory
compensation for this Acidotic condition results in Kushal
respirations, i.e., rapid, shallow Breathing (sigh
breathing) that, as the acidosis grows more severe,
becomes Slower, deeper, and labored (air hunger).
Causes of DKA:-
Very high blood sugar and low insulin levels lead to DKA.
The two most Common causes are:
• Illness. When you get sick, you may not be able to eat
or drink as much As usual, which can make blood sugar
levels hard to manage.
• Missing insulin shots, a clogged insulin pump, or the
wrong insulin dose.
Other causes of DKA include:

• Heart attack or stroke.
• Physical injury, such as from a car accident.
• Alcohol or drug use.
• Certain medicines, such as some diuretics (water pills)
and Corticosteroids (used to treat inflammation in the
body).
Risk factors:-
Things that may increase your risk of DKA are:
*Not taking insulin as prescribed or not taking insulin at all.
*Type 1 diabetes that has not been diagnosed.
*Stomach illness with a lot of vomiting.
*Infections such as pneumonia , urinary tract infection , or
sepsis.
*Heart disease, such as heart attack.
*Recent stroke
*Pregnancy
*Surgery
*Some medicine, such as steroids or antipsychotic drugs.
*Recreational drug use, such as cocaine.
*Blood clot to the lungs
*Significant illness or trauma.
Sign, symptoms:-
▪
✓Complications of DKA :-
DKA can cause complications such as ,

1- Low level of potassuim ( Hypokalemia )
2- Swelling inside the brain ( cerebral edema)
3- Fluids inside your lungs ( pulmonary edema)
4- Damage to your kidney or other organs from your fluid
loss .
5- In the absence of timely treatment, DKA progress to Coma
and death .
Diagnosis
A physical exam and blood tests can help diagnose diabetic
ketoacidosis. In
some cases, other tests may be needed to help find what
caused the diabetic
ketoacidosis.
Blood tests
Blood tests used in the diagnosis of diabetic ketoacidosis will
measure:
• Blood sugar level. If there isn’t enough insulin in the
Body to allow sugar to enter cells, the blood sugar Level will
rise. This is known as hyperglycemia. As The body breaks down
fat and protein for energy, the Blood sugar level will keep
rising.
• Ketone level. When the body breaks down fat and protein for
Energy, acids known as ketones enter the bloodstream.
• Blood acidity. A too-high blood ketone level will cause the
Blood to become acidic. This can change how organs
throughout The body work
Other tests:-
Tests that can help find health problems that might have
contributed to Diabetic ketoacidosis and check for
complications might include:
• Blood electrolyte tests
• Urinalysis
• Chest X-ray
• A recording of the electrical activity of the heart, also known
as An electrocardiogram.
Prevention:-
There are many ways to prevent diabetic ketoacidosis and
other diabetes Complications.
• Manage your diabetes. Make healthy eating and physical
Activity part of your daily routine. Take diabetes medicines or
Insulin as directed.
• Monitor your blood sugar level. You might need to check and
Record your blood sugar level at least 3 to 4 times a day, or
more Often if you’re ill or stressed. Careful monitoring is the
only way To make sure that your blood sugar level stays within
Your target range.
• Adjust your insulin dosage as needed. Talk to your
Health care provider or diabetes educator about how
To make your insulin dosage work for you. Consider
Factors such as your blood sugar level, what you eat, how
active You are, and whether you’re ill. If your blood sugar level
begins To rise, follow your diabetes treatment plan to return
your blood Sugar level to your target range.
• Check your ketone level. When you’re ill or stressed, test
your
Urine for excess ketones with a urine ketones test kit. You can
Buy test kits at a drugstore. If your ketone level is moderate or
High, contact your health care provider right away or seek
Emergency care. If you have low levels of ketones, you may
need to Take more insulin.
• Be prepared to act quickly. If you think you have diabetic
Ketoacidosis because your blood sugar is high and you have too
many Ketones in your urine, seek emergency care.
NB: DKA complications are scary. But don’t let fear keep you
from taking Good care of yourself. Follow your diabetes
treatment plan carefully. Ask Your diabetes treatment team for
help when you need it.
Medical management:-
Treatment of DKA :
(1) Fluid : first 3 hours taken 3L of Normal saline ( Within 12

hr. Take 8 to 10 L of Normal saline) .
_ Monitor blood sugar every ½ hours and CVP To detect
dehydration.
(2) Give insulin (short acting insulin) ,1ml / kg / hr.
According to patient weight with low rate. _Monitor
Potassium levels ( normal range 3,5 to 5) with cases of
DKA The potassium levels decreased
∆ If the potassium levels more than 5 not taking potassium and
treating of insulin ;
1_ if potassium levels of (4,5 _ 5 ) taking 1ampule potassium.
2_ if potassium levels of (3 _ 4,5) taking 2 ampule potassium.
3_ if potassium levels less than 3,3 taking 4 ampule.
_ Not treating of insulin until potassium levels become normal.
Nursing Management for DKA:-
• Monitor vitals
• Check blood sugars and treat with insulin as ordered
• Start two large-bore Ivs
• Administer fluids as recommended
• Check electrolytes as potassium levels will drop with insulin
Treatment
• Check renal function
• Assess mental status
• Look for signs of infection (a common cause of DKA)
• Educate the patient on the importance of compliance with
Diabetic medications
• Educate the patient on the importance of follow up
• Check urine output
• Encourage patient to quit smoking and abstain from alcohol
• Encourage a healthy diet
• Ask the patient to wear an ID bracelet signifying that he or
she Has had a DKA episode
• Check urine and blood cultures
• Listen to the lungs for rales and crackles.
Prepared by: Rania Hesham Ata.
References:-
https://www.mayoclinic.org/ar/diseases-
conditions/diabetic-ketoacidosis/symptoms-
causes/syc-20371551
https://emedicine.medscape.com/article/118361-
overview
https://www.webmd.com/diabetes/ketoacidosis
https://medlineplus.gov/ency/article/000320.htm
https://www.msdmanuals.com/professional/endo
crine-and-metabolic-disorders/diabetes-mellitus-
and-disorders-of-carbohydrate-
metabolism/diabetic-ketoacidosis-dka

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Prepared by:- Rania Hesham Ata.

Under supervision:- Dr: Mahmoud Moresy.

Diabetic ketoacidosis (DKA) is a life-threatening problem

NB: People with type 2 diabetes can also develop DKA,

Other causes of DKA include:

DKA can cause complications such as ,

(1) Fluid : first 3 hours taken 3L of Normal saline ( Within 12

Nursing Management for DKA:-

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