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DEFINITION OF DKA

• CAUSED BY ABSENCE OR MARKEDLY INADEQUATE

INSULIN WHICH LEAD TO HYPERGLYCEMIA,
KETOSIS, AND ACIDOSIS
• EXTRA FEATURE - DEHYDRATION

DKA and HHNS

DEFINITION OF HHNS PATHOPHYSIOLOGY

• A SERIOUS CONDITION IN WHICH • REFER TO WHITE BOARD

HYPEROSMOLARITY AND HYPERGLYCEMIA
PREDOMINATE
• USUALLY DUE TO INSULIN RESISTANCE
• EXTRA FEATURE - DEHYDRATION

Earlier clinical symptoms and Later clinical symptoms and

signs for DKA and HHNS signs of DKA
• Later clinical
• Polyuria • Weight loss symptoms and signs
• Nausea and vomiting of HHNS
• Polydipsia
• Abdominal pain • ALL OF THE LATE SIGNS
• Polyphagia • Dehydration OF DKA EXCEPT
• Acidotic breath ACIDOTIC BREATH OR
• Tiredness • Hypotension KUSSMAUL'S
• Muscle cramps • Shock RESPIRATION
• Altered consciousness
• Flushed facial appearance • Coma

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DIAGNOSTIC PROCEDURES

• BLOOD GLUCOSE MONITORING

• URINE GLUCOSE AND KETONES - URINALYSIS
• SERUM ELECTROLYTES AND OSMOLARITY
• ABG
• BUN AND CREATININE

MEDICAL MANAGEMENT

• 1. IV FLUID REPLACEMENT- FOR SHOCK AND

DEHYDRATION
• 2. INSULIN THERAPY
• 3. CORRECTION OF ACIDOSIS
• 4. CORRECTION OF ELECTROLYTE IMBALANCE

NURSING INTERVENTIONS NURSING INTERVENTIONS

• IV FLUID ADMINISTRATION • 2. ELECTROLYTE REPLACEMENT

– 0.9% NACL 500 ML TO 1000 ML/ HR FOR THE NEXT 2-3 – ADMINISTRATION OF IV POTASSIUM UP TO 40 MEQ PER
HOURS HOUR
– NEXT HOURS (2-3 HOURS AGAIN ) 0.9% NACL 200-500 – SERUM ELECTROLYTES EVERY 2-4 HOURS
ML/HR – ECG EVERY 4 HOURS
– CORRECTION OF UP TO 6-10 LITERS OF FLUID FOR FIRST
24 HOURS DEPENDING ON THE FLUID LOSSES

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NURSING INTERVENTIONS

• 3. REVERSING ACIDOSIS
– INSULIN INFUSION
– HOURLY GLUCOSE MONITORING
– CHANGE IV FLUIDS FROM NORMAL SALINE TO D5NS
WHEN BLOOD SUGAR REACHES 250 MG/DL
– IV INFUSION WILL CONTINUE UNTIL
• CORRECTION OF ACIDOSIS
• CORRECTION OF KETONES
• CORRECTION OF BICARBONATE LEVELS
– CHANGE IV INSULIN TO SUBCUTANEOUS INSULIN

• END OF DISCUSSION