Powerpoint on Diabetic Keto-Acidosis.pptx

FOr specialised Nursing Students throughout the caribbean

1. Objectives: At the end of this presentation, you should be able to: Explain what is Diabetic ketoacidosis. Identify the incidence of Diabetic ketoacidosis in the population. Explain the pathophysiology of the condition.

2. Outline the risk factors, causes and manifestation of the condition. Identify the diagnostic tests & pharmacological treatment for the condition. Identify common nursing diagnosis for this condition and health promotion for patients with dx with the condition.

3. What is Diabetic Ketoacidosis? Kerice Dunkley

4. Ketoacidosis is a serious complication of diabetes that develops when the body is unable to produce enough insulin. Due to insufficient insulin, the body then begins to breakdown fat as fuel, creating a buildup of acids in the blood called ketones. If this is untreated, it develops into ketoacidosis. ( Diabetic Ketoacidosis - Symptoms & Causes - Mayo Clinic , 2022)

5. Incidence of Diabetic Ketoacidosis

6. One of the most prevalent symptoms of type 1 diabetes in children is diabetic ketoacidosis (DKA). Diabetic ketoacidosis is present in 25–40% of children newly diagnosed with type 1 diabetes. After a steady increase since 2011,

7. Researchers discovered that the incidence of DKA was 55.5 per 1000 person-years. DKA has also been documented in children who are being diagnosed with type 2 diabetes for the first time. (Li et al., 2021)

8. Pathophysiology

9. Type 1 diabetic patients are typically affected by Diabetic ketoacidosis (DKA) due to the lack of insulin production in the body. Absence of insulin results in a cascade of actions in the body as it attempts to allow the cells to receive the glucose, this include: going through beta oxidation of fatty acids to later increase ketone bodies in the bloodstream (Ninja Nerd, 2020) .

10. Increase ketones body eg. acetoacetate decreases pH level in the blood making it acidic and make the patient experience kussmaul breathing. Fun Fact: Acetoacetate broken down to acetone causes “sweet breath”. Due to the high concentration of glucose in the blood, the kidneys are unable to reabsorb electrolytes efficiently resulting in diuresis that is highly concentrated with glucose and electrolytes (Ninja Nerd, 2020) .

11. Excess fluid loss caused by DKA results in increased HR, or Decrease BP among other symptoms (Ninja Nerd, 2020) .

12. Risk Factors & Causes

13. Risk Factors Age Undiagnosed Diabetes Diabetes; Type 1 & Gestational Infection or Illness Medication non-compliance Alcohol or Substance Abuse Dehydration (Diabetic Ketoacidosis, 2021)

14. Causes Malnutrition: Improper metabolism of nutrients causes fat catabolism, leading to an excess buildup of ketones and acids. Renal insufficiency, acute kidney injury, or chronic kidney disease: Increase waste products of protein metabolism are retained; acids increase, bicarbonate is unable to maintain acid-base balance.

15. High-fat diet: causes a much too rapid accumulation of the waste products of fat metabolism, leading to a buildup of ketones and acids. (Nclex -RN, 2017)

16. Manifestations

17. Early signs of diabetic ketoacidosis Includes : Increased thirst and urination. Headaches Ketones in Urine

18. As the condition progresses, more pronounced symptoms may manifest rapidly, including : Tachypnoea , Dry skin, A flushed face, Breath with a fruity odour, Headaches, Muscle weakness, and Stiffness or aches. (Diabetic Ketoacidosis, 2021)

19. Diagnostic Findings

20. ABG test - shows metabolic acidosis, low bicarbonate and low pH. Blood test - shows hyperglycemia Serum Electrolytes - shows elevated K+, low Na+, CL-, P+ Urinalysis - shows positive glucose and ketones. (Hamdy, n.d)

21. Renal Function Test - shows elevated BUN (Hamdy, n.d)

22. Pharmacological Management

23. The aim treatment for Ketoacidosis are: Fluid resuscitation with intravenous fluids Reversal of the acidosis and ketosis Reduction of plasma glucose concentration to normal Replenishment of electrolyte and volume losses Correction of hyperglycemia with insulin (Hamdy, n.d.)

24. Medications used to treat Diabetic Keto- Acidosis are: Rapid- acting insulins Short- acting insulins Electrolyte supplements Alkalinizing agents (Hamdy, n.d.-a)

25. Nursing Diagnosis

26. Deficient Knowledge related to inadequate knowledge on health regime secondary to Diabetic Ketoacidosis as evidenced by “I don't know anything about my condition”, “I don't understand why I need to take my medication”, GMR 26 mmol/L, ketones (+ +) noted, fruity breath noted, glucose in urine. (Ummu, n.d.)

27. Deficient Fluid Volume related to the kidneys inability to reabsorb water secondary to Diabetic Ketoacidosis as evidenced by “I am thirsty, exhausted and feel like I want to faint”, GMR 26 mmol/L, urine output of 150 ml/hr, K 2.9 mEq/L, poor skin turgor, dry mucous and buccal membrane noted, client appears dehydrated.(Sarwar, 2023)

28. Risk for Infection related to the immune system being compromised due to increase glucose production secondary to Diabetic Ketoacidosis. (Sarwar, 2023)

29. Health promotion

30. Instruct patient on how to perform blood glucose. Educate patient and family about Diabetic Ketoacidosis. Encourage patient to adhere to regime: insulin and diabetes medicines. Promote drinking extra fluids to prevent dehydration. Advise patient to eat as you normally do, with a focus on healthy food choices. ( Healthwise Staff, 2023)

31. Reference Diabetic ketoacidosis - Symptoms & causes - Mayo Clinic . (2022, October 6). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-2037155 1 Hamdy, O., MD PhD. (n.d.-a). Diabetic Ketoacidosis (DKA): practice essentials, background, pathophysiology . https://emedicine.medscape.com/article/118361-overview?form=fpf Hamdy, O., MD PhD. (n.d.-b). Diabetic Ketoacidosis (DKA) treatment & management: approach considerations, correction of fluid loss, insulin therapy . https://emedicine.medscape.com/article/118361-treatment?form=fpf

32. Hamdy, O., MD PhD. (n.d.). Diabetic Ketoacidosis (DKA) workUp: approach considerations, plasma glucose study, urine dipstick testing . https://emedicine.medscape.com/article/118361-workup?form=fpf#c1

33. Li, L., Andrews, E., Li, X., Doder, Z., Zalmover, E., Sharma, K., Oliveira, J. H. A., Juhaeri, J., & Wu, C. (2021). Incidence of diabetic ketoacidosis and its trends in patients with type 1 diabetes mellitus identified using a U.S. claims database, 2007–2019. Journal of Diabetes and Its Complications , 35 (7), 107932. https://doi.org/10.1016/j.jdiacomp.2021.107932 Ninja Nerd. (2020, April 29). Diabetic ketoacidosis (DKA) & Hyperglycemic hyperosmolar Syndrome (HHS) [Video]. YouTube. https://www.youtube.com/watch?v=jCf7W1U4JKE

34. Ummu, M. B. C., RN. (n.d.). 12 NANDA-I nursing diagnosis for Diabetic Keto Acidosis (DKA) |Assessment |Priorities |Interventions. Nurseship.com. https://nurseship.com/nanda-nursing-diagnosis-for-diabetic-keto-acidosis-dka/ Phn, A. C. R. B. (2022, May 16). Diabetic Ketoacidosis DKA Nursing Diagnosis and Nursing Care Plan. NurseStudy.Net. https://nursestudy.net/diabetic-ketoacidosis-dka-nursing-diagnosis/?expand_article=1 Sarwar, A. (2023b, July 23). Nursing Care Plan for Diabetic Ketoacidosis (DKA). Made for Medical. https://www.madeformedical.com/nursing-care-plan-for-diabetic-ketoacidosis-dka/ Diabetic ketoacidosis - Symptoms & causes - Mayo Clinic . (2022, October 6). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551 Diabetic ketoacidosis (DKA): Care instructions . MyHealth.Alberta.ca Government of Alberta Personal Health Portal. (n.d.). https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=tw12221