Fun Facts
Insulin was invented/discovered by this person
Sir Frederick BAnting
name the three states that bring about DKA (hint: its in the name)
Diabetes (hyperglycemia)
Ketones
Acidosis
My patient's blood work shows:
Glucose 45
Ketones present
pH 7.20
Are they in DKA?
Yes
How often will I be monitoring glucose initially?
Every hour
The Eternal Flame of is located here.
The Banting house in London, Ontario. The "birthplace of insulin"
Name three symptoms a patient could present with
N&V, Abd pain, altered mental state, weight loss, dehydration, kussmaul's breathing, fruity breath
Name 3 lab values in blood or urine and if you would expect them to be hypo or hyper
low serum sodium
high serum glucose
ketones in urine
ketones in blood
blood acidosis
A five year old comes in with DKA. First step is to give a bolus of insulin
NO
In whose hometown was insulin discovered?
Mine!
High blood sugar means water follows into the blood stream. Patients have high urine, this is called
polyuria
My patient came in DKA, and K is 3.5
The doctor has ordered potassium replacement, but that value is normal, so I will hold it.
Am I right?
No. Total body potassium will always be low secondary to dehydration
What does HIE stand for in treatment terms?
Hydration
Insulin
Electrolytes
Banting took insulin from this animal to prove his treatment:
Dog
Pig
Horse
Dog
Patients have high GL but are still starving, they want to eat all the time but are losing weight. This high appetite is called
polyphagia
This lab does not test for ketones in the blood, how else can I check for them?
Ketones in the urine, possibly urine pH
What complication do I need to be monitoring for constantly?
what should I do?
Cerebral edema, signs are altered LOC, seizure, decreased GCS
Notify MD, document and be prepared to draw blood
Banting and Best won the Nobel Prize for Medicine and Physiology in this year
1923
This symptom is the most serious complication of DKA. What is it and how does it present
Cerebral Edema: altered mental status, delirium, seizures, coma
The Calculation for Anion Gap Is...
AG=Na- (CL plus HCO3)
DKA has resolved, AG is closed, no more ketones in the blood, GCS is 15, insulin infusion is off. I'm done!
What is this nurse forgetting?
Long acting insulin 30 min before shutting off infusion. Or you will be right back in the cycle.