Diabetic Ketoacidosis (DKA) : Prepared By:yazan Masaied Instructor:Abed Asakrah

Diabetic Ketoacidosis
(DKA)
Prepared by:yazan masaied
Instructor :Abed asakrah

Diabetic Ketoacidosis (DKA)
Is a critical illness with severe hyperglycemia, metabolic acidosis, & fluid & electrolyte
imbalances.
• Mostly occurs in type I diabetics
Pathophysiology :
• Results from severe insulin deficiency that leads to disordered metabolism of proteins,
carbohydrates, & fats
Includes three major physiological disturbances:

(1) Hyperosmolality due to hyperglycemia
(2) Metabolic acidosis due to accumulation of ketoacids
(3) Volume depletion due to osmotic diuresis
Hyperglycemia & Hyperosmolality
▪ Hyperglycemia & hyperosmolality are the first major consequence of DKA.
▪ Results from excessive hepatic glucose production & high stress hormones levels (e.g.,
Cortisol & catecholamines, which further aggravate hyperglycemia by enhancing
gluconeogenesis, insulin resistance).
▪ When the blood sugar exceeds the normal , glucose begins to escape into the urine causing
glucouria to prevent extreme accumulation of glucose in blood.
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❑ Volume Depletion
• Glucoseuria contribute to volume depletion by causing osmotic diuresis.
To prevent vascular collapse & shock a variety of compensatory mechanisms are activated such
as increased in pulse rate
DKA - Causes
• The most common cause of DKA is infection, occurring in 30-50% of cases.
o UTI & Pneumonia are the major infections.
• Sever illness such as , stroke, MI, Pancreatitis, Alcohol abuse, trauma, drugs.
• Inadequate insulin therapy.
o Sudden discontinue of insulin

Signs & Symptoms
Diabetic Ketoacidosis - DX
Laboratory Studies:
o Glucose, electrolytes, osmolality, pH, ABGs, urine acetone, & glucose.
• Findings may include hyperosmolality, decreased bicarbonate (<10 mEq/L), & decreased pH
(<7.3) o Serum glucose may range from 250 mg/dL to 800 mg/dL or higher, altered level of
Sodium & Potassium, high creatinine & BUN.
Diagnostic studies: o Throat, urine, blood cultures, CXR, ECG.

Diabetic Ketoacidosis—Management
•Fluid replacement
• Insulin therapy
• Potassium & Phosphate replacement
• Bicarbonate replacement
• Reestablishing metabolic function

Fluid Replacement
0.9% (normal) saline is rapidly infused in order to restore renal perfusion.
• Fluid replacement continues at roughly 1 L/hour until hemodynamic stability

(normal heart rate, blood pressure, & urine flow),Hypotonic solutions, such as
0.45% normal saline, can be administered at a rate of 150 to 250 mL/hour
Rapid infusion of fluids in DKA may dilute plasma proteins & which allows
fluid to leak out of the ECS & contributes to the development of pulmonary
edema or cerebral edema. Therefore, patients must be observed carefully during
the first 24 to 36 hours for signs of pulmonary or cerebral edema.
Insulin Therapy
• Important as it decreases the production of ketones , inhibits hepatic gluconeogenesis
Insulin initially should be given as an intravenous bolus of regular insulin at 0.15 U/kg
body weight followed by a continuous infusion of regular insulin at a dose of 0.1
U/kg/hour.
• When the plasma glucose reaches 250 mg/dL, the insulin infusion should be
decreased & dextrose should be added to the intravenous fluids.
Potassium and Phosphate Replacement
Phosphate is usually combined with Potassium replacement in the form of

potassium phosphate salts added to the intravenous Infusion.
• Patients who are receiving intravenous Phosphate therapy should be watched

carefully for signs of hypocalcemia seizures
Bicarbonate Replacement
• Bicarbonate is administered to patients with severe acidosis as indicated by an
arterial pH of 7.0 or less, whose bicarbonate levels are initially 5 mEq/L or lower
Bicarbonate is replaced intravenously over several hours to raise the level at least
to the 10 to 12 mEq/L range.
GI Function
• Gastric distension, vomiting, abdominal pain
The patient may need a NG tube to decompress the stomach. This increases
comfort
Patient Education - DKA
Emphasize the importance of monitoring blood glucose levels regularly.
Provide guidance on a balanced diet, emphasizing the importance of carbohydrate counting.
Emphasize the need for regular follow-up with healthcare providers.
Always keep enough insulin on hand for daily injections.
Discuss the importance of staying well-hydrated to prevent dehydration.
Discuss the role of regular exercise in diabetes management.
Ensure the patient understands the purpose of each medication, its dosage, and any potential side
effects.
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Diabetic Ketoacidosis

Prepared by:yazan masaied

Instructor :Abed asakrah

Includes three major physiological disturbances:

▪ Hyperglycemia & hyperosmolality are the first major consequence of DKA.

o UTI & Pneumonia are the major infections.

• Inadequate insulin therapy.

o Sudden discontinue of insulin

o Glucose, electrolytes, osmolality, pH, ABGs, urine acetone, & glucose.

Diagnostic studies: o Throat, urine, blood cultures, CXR, ECG.

• Potassium & Phosphate replacement

• Reestablishing metabolic function

• Fluid replacement continues at roughly 1 L/hour until hemodynamic stability

• Important as it decreases the production of ketones , inhibits hepatic gluconeogenesis

Phosphate is usually combined with Potassium replacement in the form of

• Patients who are receiving intravenous Phosphate therapy should be watched

• Gastric distension, vomiting, abdominal pain

Provide guidance on a balanced diet, emphasizing the importance of carbohydrate counting.

Emphasize the need for regular follow-up with healthcare providers.

Always keep enough insulin on hand for daily injections.

Discuss the importance of staying well-hydrated to prevent dehydration.

Discuss the role of regular exercise in diabetes management.

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