ACUTE BIOLOGIC

CRISIS
Diabetic Ketoacidosis (DKA)
Hyperglycemic Hyperosmolar
Syndrome (HHS)

Associate Professor Rhea G. Gacuya, RN,MAN

St. Luke’s College of Nursing
Diabetic Ketoacidosis
▪ is a metabolic derangement
characterized by hyperglycemia,
metabolic acidosis, and ketosis
Hyperosmolar Hyperglycemic
Syndrome
▪ syndrome characterized by
severe hyperglycemia,
hyperosmolality, and dehydration
in the absence of ketoacidosis
 DKA
• Insulin Deficiency- glycogenolysis, gluconeogenesis
• Hyperglycemia
• Fluid Volume Deficit- polyuria ,glycosuria
• Ketoacidosis-acetoacetate, B-hydroxybutyrate, acetone
• Acid Base Balance
 HHS
• Decreased insulin- glucagon release
• Extreme hyperglycemia
• Profound dehydration
• Hypovolemia
 COMPARISON OF DKA AND HHS
CHARACTERISTICS AND DKA HHS
LABORATORY TESTS
ONSET Sudden (hours) Slow, insidious (days,
weeks)
PRECIPITATING Noncompliance medication, Illness, infection (older
FACTORS illness, surgery patient)
POPULATION Type 1 Type 2
AFFECTED
 COMPARISON OF DKA AND HHS
CHARACTERISTICS AND DKA HHS
LABORATORY TESTS
MORTALITY (%) 9-14 10-50
CLINICAL MANIFESTATIONS Dry mouth, polydipsia, polyuria, Mental confusion, tachycardia
polyphagia, dehydration, dry skin,

Ketoacidosis : air hunger acetone

breath odor, respirations deep and
rapid
CHARACTERISTICS AND LAB DKA HHS
Laboratory 300 to 800 600 to 2000
Glucose (mg/dl)

Ketones Strongly positive Normal or mildly elevated

pH <7.3 Normal
Osmolality(mOsm/L) <350 >350
Sodium Normal or low Normal or elevated
Potassium Normal, low or elevated Low, normal or elevated
Bicarbonate <15 mEq/L Normal
Urine Acetone Strong Absent or mild
 PHARMACOLOGIC MANAGEMENT(DKA)

0.9 % NaCL, Bicarbonate Regular Potassium

0.45% Nacl Insulin
 HHS
Medical management
• IV insulin administration therapy
• Fluids
• Electrolytes

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 NURSING MANAGEMENT DKA/HHS
• Monitor blood glucose
• Hourly urine output measurements
• Cardiac monitoring
Thank You!