Alterations in Pancreatic Function: DKA (Nursing)

00:00 In this presentation, we're going to talk about an emergency situation that happens in patients that have diabetes and that is called diabetic ketoacidosis more commonly referred to as DKA. So we're going to talk about what the definition of DKA is, some causes and risk factors, presentation, what it's going to look like when patients have DKA, and we're going to talk about diagnosis and assessment.

00:29 So, what is diabetic ketoacidosis? It is defined by the presence of all of the following in a patient with diabetes. So, the patient has hyperglycemia. So normally we would hope that a diabetic patient is really going to keep control of their insulin management and they're going to keep that blood sugar in a good range, but sometimes it happens that that blood sugar gets out of control, it gets too high, and generally if it's greater than 200 it's going to start to cause some problems. You also have to have the presence of metabolic acidosis. So, this is going to be explained a little bit more in detail later, but just remember that when you have metabolic acidosis that means the pH of your blood is going to be too low and for diabetic ketoacidosis it's really we're looking for that venous pH and it's going to be less than 7.3. You can also look at the bicarbonate level of a patient and if that's less than 15 that will also mean that your patient is acidotic. The last thing that we're looking for for DKA is ketosis. Right there in the name, right, diabetic ketoacidosis. I love it when they make it simple for us. You have acidosis and you have ketosis, right there in the name. So, the presence of ketones in the blood or the urine. If you are measuring ketones in the blood, you're measuring beta-hydroxybutyrate, I know that's a mouthful, but you'll get used to seeing that term and when you're measuring the presence of ketones in the urine that's when you're dipping the urine and you're looking to see for those ketones. We're going to talk about some precipitating factors for DKA or things that might cause a patient that has diabetes to go in to DKA. There are a couple of categories of things that can cause DKA. So, if a patient is put on a particular drug, is given a prescription for something like corticosteroids, maybe high doses of thiazides, some of the second generation antipsychotics, those are examples of drugs that can precipitate or cause DKA. Many times children present with DKA because they've had an illness, perhaps they've had a respiratory illness or they have had a stomach bug, something that is making them not feel very well and that could cause the symptoms to get worse and can cause children to go in to DKA. Endocrine dysfunction can also precipitate DKA. Sometimes it's a new diagnosis of diabetes and so the diabetes is not being controlled at all and it presents with DKA.

03:17 Non-compliance with insulin for people who haven't established diagnosis of diabetes, sometimes teenagers don't want to take their insulin and they will just let that blood sugar get higher and higher until they start having difficulty and present with DKA. Sometimes it's because the insulin therapy is inadequate. Maybe they needed adjustment in their doses. So, again, when you think of teenagers who are going through puberty, we know those hormones are going all over the place and insulin is a hormone. So, we really have to make sure that worst thing on top of the dosing and if they've had big changes and haven't had changes in their insulin dosing, then they may present with DKA even though they're taking the dose they we're prescribed. So it's not always the teenager's fault. Additionally, there are a few conditions that can cause decreased effectiveness of insulin that isn't necessarily associated with diabetes so acromegaly, thyrotoxicosis, and cushing's disease are a couple of examples of this.