Diabetic Ketoacidosis (DKA): Clinical Features and Causes (Nursing)

00:00 Diabetic ketoacidosis can be a life-threatening emergency.

00:05 So I know that you're studying because you want to do the best for all of your patients, particularly those that are in extreme distress like DKA can cause.

00:14 So let's review the clinical features.

00:16 What is it about DKA that makes this such an emergency? Well, first of all, DKA evolves rapidly.

00:23 The patient could be fine, and then within 24 hours, they're in full-blown DKA.

00:29 So first, let's talk about the earliest symptoms of really high blood sugar or hyperglycemia.

00:35 The earliest symptoms are going to be things like polyuria.

00:39 They're going to the bathroom to pee a lot.

00:42 Now, because they're peeing so much, they're going to have polydipsia, which means you're really, really thirsty.

00:48 And the third one is weight loss.

00:50 All three of these are going to go together.

00:52 High blood sugar, you're peeing a lot because your body is trying to find this homeostasis, and your blood is super concentrated with all of that glucose.

01:00 Now, because you're peeing a lot, you're really thirsty, so you're wanting to drink more, but you just will not be able to keep up with the volume loss, and that's why the client will experience weight loss.

01:12 Okay, so those are the early symptoms.

01:14 We're also going to have some other symptoms that really aren't any fun, right? Because if they're starting to develop the ketoacidosis, they might have signs that are kind of GI involved, nausea, vomiting, and abdominal pain.

01:27 So again, these could all happen in the early stages.

01:30 Now, the last one seems kind of unique unless you remember diabetic ketoacidosis is a state where the pH of their blood is acidotic.

01:41 So even in the early symptoms, a client will hyperventilate.

01:44 They'll breathe a much faster rate than normal because their body is trying to compensate for the pH of their bloodstream by blowing off CO2.

01:53 If you think of CO2 as an acid in the blood, the more that you can blow off, that's an attempt to compensate or to bring the pH back to normal.

02:02 Okay, those are the earliest symptoms.

02:05 Pause for just a minute and see how many of those you can remember without looking at your notes.

02:10 Good.

02:13 Next, what I want you to do is see if you can pause the video again and explain why they're peeing so much, why they're so thirsty.

02:21 Walk through all those again and see if you can explain the why.

02:24 This will help it stick in your mind.

02:29 Okay, hopefully you're doing well in studying with us.

02:32 Don't worry if you miss some things.

02:34 That's perfectly normal.

02:36 Just make a note to yourself and know that when we're done studying with this video, you should go back and review those right away so you can help lock it into your brain.

02:44 So we know that decay evolves rapidly over a 24-hour period.

02:48 We've talked about the earliest symptoms and why patients have those symptoms when they have really high blood glucose.

02:55 Now let's take a look at what happens as that hyperglycemia goes on for an extended period of time and it even worsens.

03:03 This tells us things are getting even more serious.

03:06 Now the patient, if they're starting to show you neurological symptoms, this is not a good sign.

03:12 So we know if they're getting, they might get just lethargic.

03:15 They might have some focal deficit problems.

03:17 It might become disoriented.

03:19 They might even progress to seizures and coma.

03:22 Any of these neurological symptoms are definitely an indication that the hyperglycemia is getting worse.

03:29 Now, how does someone end up here? Well, I want you to be very familiar with the most common causes of DKA because you want this to be clear in your mind.

03:38 So you'll be on the lookout.

03:40 You'll know who you should ask these questions.

03:43 Sometimes a client will come in and they know they're diabetic and they're receiving insulin.

03:47 But other times a client might come in and they don't know that they're diabetic.

03:52 And this experience of DKA is sadly the way they find out.

03:56 But let's look at the most common causes that could end a patient up in DKA.

04:01 First off, I want to start with this one because it's infection.

04:05 This can happen with a client who is compliant with their medications.

04:09 They're watching their diet.

04:10 They're doing everything right.

04:12 But the experience of an infection in the body can throw the glucose up to a higher level.

04:17 It's a stress response, right? So when you're having an infection, your body has this stress response to it and the inflammatory response.

04:25 And that can elevate anyone's blood sugar level, but particularly somebody who is diabetic.

04:31 Now, when we talk about insulin, we know the patient doesn't have enough insulin.

04:34 And someone who's known diabetic, they have to take insulin as a medication.

04:40 If they're not getting an appropriate amount of insulin, this is going to cause them to have higher and higher blood sugar.

04:47 So let's think without judgment.

04:49 What are the reasons somebody could not be getting enough insulin to meet their body's needs? Well, we talked about infection because that might mean that their body is now needing more and more insulin to handle a higher blood sugar.

05:02 And the client wasn't aware of that if maybe they didn't know that their blood sugars were rising.

05:07 But there's also a group of patients that don't get enough insulin just as it was ordered by their healthcare provider.

05:14 This can happen for several reasons.

05:16 Insulin is really, really expensive.

05:19 So sometimes people don't have the financial resources to take the insulin as their healthcare provider has prescribed.

05:27 You'll hear stories of people that can only afford a certain amount a month.

05:30 And so they try to just make that last longer than it really should.

05:33 They're at risk for developing DKA.

05:36 Now, they might also just not be able to wrap their head around having to give themselves shots and to take insulin.

05:42 So for that reason, they are not following the healthcare provider's orders.

05:47 The last thing I want you to keep in mind is someone might be on some type of equipment like an insulin pump.

05:53 And it may dysfunction.

05:55 It may not work right.

05:57 And you end up having the patient not receive the amount of insulin they think they are getting.

06:03 This can also lead to DKA.

06:05 Here's the biggest takeaway point.

06:07 This is where you have to be very careful that you don't judge.

06:11 You just are curious and you ask questions to try to figure out how the client got into DKA.

06:17 So together, you can problem solve as they progress and get better on how they don't end up in DKA again.

06:23 Okay, so if it's infection, you're going to do patient education.

06:27 If there's some reason they're not getting the insulin, you're going to figure out what that is and try to help the patient problem solve.

06:33 Now, I told you that sometimes people know they're diabetic.

06:36 Sometimes they don't.

06:37 So another common cause of DKA is this is their introduction to diabetes.

06:42 They end up in the ER because they have all these symptoms that we've talked about.

06:46 But they don't know that they're diabetic.

06:49 So this is sadly some ways that people get initially diagnosed.

06:53 Now, the last one, you might not see how does this fit with everything.

06:57 Makes sense, infection, because you've got that stress response.

07:00 Make sure if you're not getting the appropriate insulin, that's going to be a problem, whether you're a diagnosed diabetic or a new onset diabetic.

07:07 But the last one I want to keep in mind is myocardial ischemia.

07:12 So if you have a client who's actually a known diabetic and they have a heart attack, we're going to watch those glucose levels very, very carefully.

07:19 Because we know following a myocardial ischemia or a heart attack, they're at higher risk to develop DKA.