Diabetic ketoacidosis (DKA): Nursing process (ADPIE)

Juanita Perez is a 58-year-old female client with a history of Type 1 diabetes mellitus.

Mrs. Perez was brought to the Emergency Department (ED) late last night by her spouse, with complaints of severe lethargy, nausea, and a high blood glucose reading at home.

In the ED, she was found to have a blood glucose reading of 450 mg/dL.

She was immediately transferred to the Intensive Care Unit, or ICU with the diagnosis of diabetic ketoacidosis.

Diabetic ketoacidosis or DKA, is a serious complication of diabetes mellitus.

It occurs more commonly in type 1 vs type 2 DM because the cause is severe insulin deficiency.

When insulin levels are low, cells in the body can’t utilize glucose, so fat will be metabolized for energy instead.

The liver breaks down fat into Ketone bodies and as they build up in the blood, it causes a decrease in pH, leading to acidosis.

Risk factors for DKA include inadequate insulin administration, concurrent infection or illness, trauma, and injury.

DKA has a very sudden onset and it starts with a severely insufficient amount of circulating insulin.

If there’s not enough insulin, glucose is unable to enter cells to be used for energy.

The unused glucose builds up in the blood, causing hyperglycemia.

At this point the cells are really starving for glucose even though it’s plentiful in the blood.

So the liver releases glycogen and initiates glycogenolysis, where stored glycogen is broken down into glucose.

This is accompanied by the release of other counterregulatory hormones - cortisol, growth hormone, and catecholamines - which oppose the effects of insulin and initiate the breakdown of proteins to make additional glucose, a process called gluconeogenesis.

Blood glucose readings with DKA will typically be anywhere between 300-800 mg/dL.

As glucose levels increase, the renal threshold for glucose resorption is surpassed, which is why we’ll observe polyuria, glycosuria and dehydration caused by the loss of large volumes of urine laden with glucose.