Diabetes Simulation (DKA) Fall 2015 Preparation Questions

1. Describe the pathophysiologic changes in DKA.
In DKA, insulin deficiency causes the body to metabolize amino acids and triglycerides for energy instead of glucose. This leads to the production of ketones which are acidic and cause metabolic acidosis. Hyperglycemia in DKA causes osmotic diuresis in kiidneys and ketones, water, Na, and K are excreted.

2. What are the commonly seen blood glucose levels?
70-130 is for normal non DKA, In DKA levels are 250-600+.

3. What fluid and electrolyte disturbances commonly occur and why?
Hyperglycemia due to insulin deficiency causes an osmotic diuresis that leads to marked urinary losses of water and electrolytes. Urinary excretion of ketones causes additional losses of Na and K. If serum K is not monitored and replaced as needed, life-threatening hypokalemia may develop.
4. What acid-base disturbances commonly occur and why?
Insulin deficiency causes the body to metabolize amino acids and triglycerides for energy instead of glucose. This leads to the production of ketones which are acidic and cause metabolic acidosis.

5. Describe the medical management and nursing management of a patient in DKA. Hydration – fluid replacement initially rapid 0.9% NS to restore fluid balance
Insulin – rapid or short acting insulin IV to bring blood glucose below 250.
Electrolytes – Na deficiency treated with 0.9% NS. Once fluid balance restored may switch to lactated ringers to restore potassium levels or supplement per provider order.

6. How is fluid status monitored in the acute stage of DKA?
Close monitoring of I&O. Serum electrolytes.

7. How is hypovolemia corrected? How rapidly is fluid volume replaced? Why?
IV NS 0.9% rapid infusion, then titrate down (100-150ml/hr) once therapeutic levels achieved, to restore fluid balance and electrolytes.