Overview of Diabetic Ketoacidosis PPT.pptx

This presentation contain complete overview of diabetes mellitus type II complications, Diabetic ketoacidosis. This presentation contains patient history and complete scenario and on the basis of which we have conducted a presentation and we have presented complete nursing and medical management of Diabetic ketoacidosis. This presentation has complete information regarding diabetic ketoacidosis. This presentation has the complete overview of diabetes and then sign and symptoms of DKA and also causes and management. This presentation have complete teaching for diabetic patients.

1. ACC Case-Based Presentation: Diabetic KetoAcidosis Presented By: Tariq Ali Waheed Ullah

2. Demographic Data of the Selected case ​. Application of appropriate theoretical framework / model for providing holistic care of the patient. Application of Evidenced Based Nursing Practice ​. 01 Integrate the concepts with physiological , pathological, Health Assessment, and pharmacological processes in selected case studies. 02 Critical Analysis and Multidisciplinary Approach 04 Integration of knowledge on Health Promotion, Prevention, Management, and Restoration 05 Objectives 03 06 Role of APN

3. A 24-year-old female patient with K/C of DM was admitted to AKUH internal medicine department under the care of the Internal Medicine team. According to the patient, she was in his usual state of health 2 weeks back when the patient had decreased appetite and was also non-compliant with medications. She continued to have generalized body aches and abdominal pain. The patient developed chest pain 2-3 days back which progressed and become severe. The patient had 4-5 episodes of vomiting moderate in quantity, and urinary frequency increased. Case Study

4. MR# : 123-45-67 (Pseudo) Age: 24 years Gender: female Residence: Karachi Marital Status: unmarried Height: 160 cm Weight: 54 kg Patient Demographic Data

5. Physical Examination on Admission Blood Pressure: 110/69 Pulse: 112 /min Temp: 36.6 C Respiration: 26 Saturation: 94%

6. Past Medical History Diabetes Multiple Admissions Admitted at AKUH Due to DKA Diagnosed Due to hyperglycemic state 2017 2017 2023

7. Review Of System 7 General: Patient reports Generalized weakness. HEENT : No significant findings. Respiratory System : Patient reports difficulty in breathing Cardiovascular : Patient reports chest pain , Gastrointestinal: Report Abdominal pain and vomiting . Neurological: No significant findings . Musculoskeletal: No significant findings SKIN: Pallor

8. 8 Lab. Investigation Result (Admission) Lab. Investigation Result CBC 7.2 RFTs Heamoglobin 9.6 Creatinine 0.7 0.7 HCT 31.4 22.3 Sodium 137 137 WBC 13.3 104.7 Potassium 3.6 3.6 Plateletes 210 2.6 Chloride 104 104 ABGS 64 Bicarbonate 15.1 15.1 PH 7.30 31.3 OTHER PCO2 27.0 Urine DR + 4 Ketone Bodies +Ketone Bodies PO2 45.0 96 Hb A1C 11.6 11.6 BIC 12.9 Albumin 3.7 3.7 Base -11.8 Calcium 7.6 7.6 O2Sat 73.2 Magnesium 1.7 1.7 Anion Gap 23 Phosphate 4.0 4.0

9. Home Medications 9 Drugs Uses Insulin glargine ( 22 units daily) Long acting Insulin to control blood glucose level Insulin Novarapid (10-8-8) Short acting Insulin to control blood glucose level Tab DAPA ( Dapagliflozin) (5mg) Helps in excretions of blood glucose in urine resulting in optimized blood glucose level Tab Lipiget 10mg ( Atorvastatin) Antilipids. Helps lower blood cholesterol level Tab Glucophage 750mg ( Metformin) Helps control Blood Glucose level

10. Differential Diagnosis 10 Diabetic ketoacidosis Hyperglycemic Hyperosmolar state

11. Type I: Beta cells destroyed by the autoimmune process Type 2: Decreased insulin production and decreased sensitivity to insulin DIABETES MELLITUS Is a group of metabolic diseases characterized by increased levels of glucose in the blood resulting from defects in insulin secretion, insulin action, or both.

12. TYPES OF DIABETES TYPE 1 DM TYPE 2 DM Genetic susceptibility Autoimmune Glycosuria Fat breakdown DKA Resistance Decreased production Generally no fat breakdown HHS

13. IDF Diabetes Atlas 2022 report Prevalence of Diabetes Worldwide

14. IDF Diabetes Atlas 2022 report Prevalence of Diabetes in different regions

15. (Azeem et al., 2022)

16. Diabetic Ketoacidosis Diabetic ketoacidosis (DKA) is a severe, potentially fatal complication of diabetes characterized by hyperglycemia, ketoacidosis, and ketonuria. Diabetic ketoacidosis (DKA) is the most prevalent acute hyperglycemic emergency among diabetes mellitus. (Osama Hamdy , 2022)

17. Hyperglycemia: of > 300 mg/dl & glucosuria Ketonemia and ketonuria Metabolic acidosis: pH < 7.3 and serum bicarbonate < 15 mmol/l. Criteria for DKA ( Dhatariya et al., 2020)

18. Globally, around 65,000 children aged under 15 years develop type 1 diabetes each year, and up to 80% present with DKA. In developing countries, it ranges from 6% to 24% (Kidie et al., 2021). DKA accounts for 14% of all diabetes-related hospital admissions and 16% of all diabetes-related fatalities. Almost 50% of diabetes-related hospitalizations in adolescents are due to DKA. Although the precise incidence is unknown, it is estimated to be 1 in 2000 (Osama Hamdy , 2022) . Prevalence of DKA

19. ( Dhatariya et al., 2020 ) Historical background of DKA

20. Jean-Louis Chiasson et al. CMAJ 2003;168:859-866 Pathophysiology

21. SIGNS & SYMPTOMS OF THE DKA Polyuria Fatigue Mental status changes polydipsia Weakness Vomiting Abdominal pain Kussmaul breathing Tachycardia Hypotension El- Remessy , A. B. (2022).

22. CAUSES AND RISK FACTORS Infections Missing insulin Dose Consistent Hyperglycemia Prolonged levels of stress

23. Insulin therapy Electrolytes Replacement Fluid resuscitation Acid-Base Balance TREATMENT PLAN Maintain serum glucose level Prevent from Complication El- Remessy , A. B. (2022).

24. Management of DKA ( El- Remessy , A. B. (2022).

25. Drugs R oute M echanism of action Adverse Effect Inj Ceftriaxone 2gm IV Inhibiting the mucopeptide synthesis in the bacterial cell wall Itching; hives; hoarseness; any swelling of your hands, face, or mouth Inj Paracetamol 1000mg IV Inhibit prostaglandin synthesis in the CNS and, to a lesser extent, block pain impulses through a peripheral action liver injury, Anorexia, nausea, diaphoresis Humalog Insulin (infusion) IV Replacing the insulin that the body typically produces and assisting in the movement of sugar from the blood into other body tissues where it is utilized for energy. Weight gain, hypoglycemia, swelling in hands and feet. Metoclopramide 10mg IVBP Stimulates motility of upper GI tract. Blocks dopamine/serotonin receptors in chemoreceptor trigger zone. Dizziness, anxiety, headache, insomnia, breast tenderness Pharmacological Intervention

26. Prevention of DKA ( Ehrmann et al., 2020)

27. Conceptual framework of risk factors for the development of diabetes Black, S. (2002).

28. Multidisciplinary Approach Internal Medicine Endocrinology Intensivist Nephrology APN Nutritionist

29. Planning Implementation Evaluation Assessment Ongoing APN role through Ida Jean Orlando concept Diagnosis ROLE OF APN

30. References: Ehrmann , D., Kulzer, B., Roos , T., Haak , T., Al-Khatib, M., & Hermanns , N. (2020). Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes. The Lancet Diabetes & Endocrinology , 8 (5), 436-446. Dhatariya , K. K., Glaser, N. S., Codner , E., & Umpierrez , G. E. (2020). Diabetic ketoacidosis. Nature Reviews Disease Primers , 6 (1), 40. Kidie, A. A., Lakew , A. M., & Ayele , T. (2021). Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia. Diabetes Metab Syndr Obes , 14 , 4819-4827. https://doi.org/10.2147/dmso.S326537 El- Remessy , A. B. (2022). Diabetic Ketoacidosis Management: Updates and Challenges for Specific Patient Population.  Endocrines ,  3 (4), 801-812.

31. Acknowledgment Ms. Arusa Lakhani Ms. Sehrish Sajjad Dr. Salma Rattani