Ketoacidosis (DKA)

  1. General information
    1. Acute complication of diabetes mellitus characterized by hyperglycemia and accumulation of ketones in the body; causes metabolic acidosis
    2. Occurs in insulin-dependent diabetic clients
    3. Precipitating factors: undiagnosed diabetes, neglect of treatment; infection, cardiovascular disorder; other physical or emotional stress
    4. Onset slow, may be hours to days
  2. Assessment findings
    1. Polydipsia, polyphagia, polyuria
    2. Nausea, vomiting, abdominal pain
    3. Skin warm, dry, and flushed
    4. Dry mucous membranes; soft eyeballs
    5. Kussmaul's respirations or tachypnea; acetone breath
    6. Alterations in LOC
    7. Hypotension, tachycardia
    8. Diagnostic tests
      1. Serum glucose and ketones elevated
      2. BUN, creatinine, hct elevated (due to dehydration)
      3. Serum sodium decreased, potassium (may be normal or elevated at first)
      4. ABGs: metabolic acidosis with compensatory respiratory alkalosis
  3. Nursing interventions
    1. Maintain a patent airway.
    2. Maintain fluid and electrolyte balance.
      1. Administer IV therapy as ordered.
        1. normal saline (0.9% NaCl), then hypotonic (0.45% NaCl) sodium chloride
        2. when blood sugar drops to 250 mg/dl, may add 5% dextrose to IV.
        3. potassium will be added when the urine output is adequate.
      2. Observe for fluid and electrolyte imbalances, especially fluid overload, hypokalemia, and hyperkalemia.
    3. Administer insulin as ordered.
      1. Regular insulin IV (drip or push) and/or subcutaneously (SC).
      2. If given IV drip, give with small amounts of albumin since insulin adheres to IV tubing.
      3. Monitor blood glucose levels frequently.
    4. Check urine output every hour.
    5. Monitor vital signs.
    6. Assist client with self-care.
    7. Provide care for the unconscious client if in a coma (see Interventions, Care of the Unconscious Client).
    8. Discuss with client the reasons ketosis developed and provide additional diabetic teaching if indicated.