Diabetic Ketoacidosis

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Diabetic Ketoacidosis
July 2006
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Diabetic ketoacidosis

• Session outline
• What is ketoacidosis?
• Causes.
• Clinical features.
• Treatment.
• Prevention.

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What is ketoacidosis?

• Results from an absence of insulin (type 1
  diabetes only).
• Low levels of insulin means that glucose cannot
  nourish cells.
• Tissues become starved for glucose.
• To prevent cell death from starvation the body
  breaks down fat and muscle for energy, resulting
  in a bi-product called ketones.

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Causes and contributing factors

• Illness or infection.
• Inadequate insulin dose.
• First presentation of type 1 diabetes.
• Myocardial infacrction, CVA.
• Trauma, surgery.

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Clinical features of DKA

• Signs of hyperglycaemia.
• Dehydration.
• Ketonuria.
• Hyperventilation.
• Ketotic breath.
• Disturbed conscious state and shock.

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Clinical features

• Gastrointestinal nausea, vomiting, abdominal
  pain.
• Respiratory dyspnoea (difficulty breathing) or
  Kussmauls respirations (air hunger).
• Electrolyte imbalance due to polyuria, ketonuria
  and acidosis there is a loss of body potassium.

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Treatment

• Goals
• To correct fluid and electrolyte imbalance.
• To correct metabolic acidosis.
• Provide insulin to lower glucose.
• Identify precipitating factors to prevent
  recurrence.

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Treatment

• Assessment and history
• Laboratory analysis.
• Electrolyte and osmolality
• (K and Na NCO3)
• Arterial blood gas (metabolic acidosis).
• State of dehydration.
• Cause of ketoacidosis.

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Treatment

• Fluid
• Normal saline initially.
• Add potassium if needed - refer to hospital
  protocol.
• BGL less than 20mmol change saline to dextrose
  and initially maintain BGL between 10 -15mmol/L.

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Treatment

• Insulin
• Insulin infusion.
• Once glucose is less than 20mmol/L change IV
  fluids to 5 Dextrose and commence hourly insulin
  sliding scale.

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Monitoring ketoacidosis

• Glucose.
• Electrolytes.
• Arterial blood gas.
• Urine output.
• Clinical state.

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Prevention

• Patient and family education.
• Appropriate sick day management.
• Ketone testing in type 1 diabetes, during illness
  or when BGL is 15mmol/L.
• Staff education with regard to diagnosis and
  treatment.
• Consideration of psychological aspects.