Symptoms
Nausea & Vomiting
What are two gastrointestinal symptoms of DKA?
Aggressive rehydration
Patients can be 5-7 L
deficient in fluids due to osmotic diuresis
What is the first step in treating DKA?
Hypokalemia
What is a common electrolyte imbalance seen in DKA?
To provide insulin and correct acidosis.
Insulin is the key!
What is the primary goal of DKA management?
True or False: IV Insulin can be administered as a secondary infusion.
False.
Insulin should always be administered as a primary infusion.
Kussmaul Respirations:
Large tidal volumes with rapid frequency and labored effort. Body’s attempt to blow off CO2 during metabolic acidosis.
What type of breathing
is commonly associated with DKA?
Potassium
•Initial K+ can be falsely due to dehydration
•If K+ is ↓, insulin will further ↓ K+ level
What electrolyte must be closely monitored and replaced during DKA treatment?
Pulmonary edema
For several reasons: permeability of capillaries, altered fluid shifts, aggressive rehydration
What is a potential respiratory complication that can occur in patients with DKA?
HCO3 ≥15 mEq/L
pH >7.3
Anion gap ≤12 mEq/L (closed)
Beta-hydroxybutyrate <3.0
Normal osmolality
Regain of mental status
What is the criteria for resolving DKA?
Insulin (DKA/HHS)
DKA/HHS is weight based, hyperglycemia only is units/hr.
What label should be used in Drug Library for IV Insulin?
Polydipsia (excessive thirst), polyuria (excessive urination), and weight loss.
What are three early symptoms of DKA?
Regular insulin
This is the only insulin that can be used intravenously.
What type of insulin is typically used in the treatment of DKA?
Arrhythmias
Both electrolyte imbalances and acidosis can affect cardiac conduction.
What cardiac complication can arise due to electrolyte imbalances in DKA?
Hourly
How often should blood glucose levels be monitored during DKA treatment?
2 hours after SQ dose.
When should the insulin infusion be stopped after SQ insulin administration?
Confusion and lethargy
Plasma osmolality shifts water out of brain cells, causing them to shrink, disrupting normal function.
What mental state changes might a patient with DKA experience?
When blood glucose ≤ 250 mg/dL
Hyperglycemia will resolve before the acidosis will. Add dextrose to continue giving insulin.
Insulin is the key!
At what blood glucose level should the dextrose be added to maintenance fluids during DKA treatment?
Acute kidney injury
What is the potential renal complication of severe dehydration in DKA?
Bicarbonate is generally not recommended unless pH is below 6.9.
What is the role of bicarbonate in DKA management?
1.2 RNs independently comparing label with MAR
2.2 RNs assuring accuracy of infusion pump programming and blood glucose result.
Additional safeguards include smart pump technology, medication barcode technology, and Pink insulin bag label and line label.
Insulin, a high alert medication, requires an independent check. What does this entail?
Acetone
The result of breaking down fats for energy and producing ketones, including acetone.
What causes the fruity odor in the breath of a patient with DKA?
1.↓ Insulin infusion to 0.02 units/kg/hr
2. Administer D50 IV
(Insulin is not stopped – insulin is the key!)
What interventions should be performed for a DKA patient with a blood glucose of 70-99 mg/dL?
Cerebral edema
What is the risk of over-correcting hyperglycemia too quickly in DKA treatment?
Start with 0.9% saline, then switch to 0.45% saline once the patient is hemodynamically stable
What is the recommended fluid replacement strategy for a patient with DKA?
True or False:
When priming IV insulin tubing, some insulin (10-20 mL) must be “wasted” due to absorption into tubing.
False:
Routine priming of IV tubing is sufficient. Extra runoff is not recommended. A small amount of insulin loss occurs through adsorption to plastic tubing; however, clinical evidence is lacking to support the utility of extra runoff.