Diabetic Ketoacidosis

(DKA)
Cindy, Chelsea, Kim, Jessa
What is DKA?

A life threatening diabetes complication where

the body produces excess blood acids

Most likely occurs in T1 diabetic

patients

Characterized by hyperglycemia,
ketosis, acidosis, and dehydration.
Pathophysiolog
y
An insufficient amount of circulating insulin leads to improper usage of glucose.

This causes the body to compensate by breaking down adipose tissue as the source for
fuel.

Acidic byproducts of the broken down fat are ketones.

Ketones, when excessive in the blood alter the pH balance and cause metabolic
acidosis.

Vomiting results in fluid and electrolytes losses. Eventually leading to hypovolemia

followed by shock.
Clinical Manifestations
● Dehydration
● Weakness
● Confusion
● Extreme Thirst
● Abdominal pain
● Vomiting
● Kussmaul Respirations
● Fruity smelling breath
 Diagnos
● is
History and physical exam
● Labs: CMP, CBC, UA, ABGs
○ Significant lab values: blood glucose
>250mg/dL, bicarb <16, blood pH < 7.30,
ketones and glucose in the urine or serum
○ Other important lab findings: BUN > 30
mg/dL, creatinine > 1.5 mg/dL, high anion
gap, electrolyte imbalances
● EKG
 DKA Treatment
1. Airway and breathing: administer O2 via NC or non-
rebreather mask
2. Initiate IV fluid replacement
3. Regular insulin
a. FSBS q1 until <250 mg/dL, then q2
4. Potassium replacement
a. <3 mEq/L - hold insulin and replace 40-80 mEq
b. 3.1-3.4mEq/L - 40-60 mEq
c. 3.5-3.9mEq/L - 20-40 mEq
5. Other electrolyte replacement if necessary
6. Once glucose reaches 250 mg/dL: add dextrose to IVF
and place on consistent carbohydrate diet
Severe Electrolyte Imbalance Complications

Hypovolemia

Shock

Additional Complications
Renal Failure
● Cerebral edema
Comatose ● Acute Renal Failure
● Hypoglycemia
Death
Patient
Education
● Educate pt as well as family on signs and symptoms of
DKA
● Monitor glucose levels at home, every 3-4 hours if ill
○ If BS > 250, test urine for ketones at home
● Take medications as prescribed
● Fluids to prevent dehydration
● Advise pt to wear a MedicAlert bracelet
Reference
s
Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2017). Medical-surgical nursing: Assessment and

management of clinical problems (10th ed.). St. Louis, MO: Elsevier.

Westerberg, D. P. (2013). Diabetic ketoacidosis: evaluation and treatment. American Family Physician, 87(5),

337-346.