Diabetic Ketoacidosis: Pathological Processes (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 So ketosis and ketoacidosis is a question I always get.

    00:06 Some people are looking for dietary ketosis.

    00:08 They're doing what we call the keto diet, and people ask me, hey, is that the same as diabetic ketoacidosis? No, it's not.

    00:16 So let me give you a quick breakdown in case you get this question from your clients or maybe you're interested in knowing for your own self.

    00:24 So ketosis is a normal metabolic state.

    00:27 Your numbers run about 1 to 6 ketones in the blood.

    00:31 Now this means your body is burning fat as energy and it actually can do that pretty efficiently.

    00:38 That is different than somebody who's in ketoacidosis.

    00:43 Now, this is a dangerous metabolic state.

    00:46 Look how much higher the ketones are.

    00:48 Yeah instead of ketosis being 1 to 6, now in ketoacidosis, it's 15 to 30.

    00:55 That's the level of ketones in the blood.

    00:58 This is what happens to type 1 diabetes.

    01:01 If you hear someone say a keto diet is like what a diabetic client goes through that is not correct at all.

    01:08 Usually people following the keto diet do have insulin in their bodies and things are functioning but they're just trying a different method or a way to furnish their body with fuel.

    01:18 Diabetic ketoacidosis is a dangerous metabolic state.

    01:24 Well, I bet you didn't expect this to happen in the middle of our video, right? A nice couch with comfy pillows.

    01:29 Well, that's because this is my couch of homeostasis.

    01:33 You may remember this from our ABG series, but right in the middle, that's where the couch is the most comfortable and so is your body.

    01:41 So I use that middle portion of the couch to represent a pH of 7.35 to 7.45.

    01:49 Now remember we get the pH through arterial blood gases or ABGs but I wanted you to have another visual picture to remember metabolic acidosis is dangerous imbalance for your patient.

    02:03 Well, what is the connection to metabolic acidosis and DKA? Well DKA is a cause of being in metabolic acidosis.

    02:14 Renal failure is a cause of being in metabolic acidosis.

    02:18 So I want you to know that DKA is just as dangerous as if we have somebody in renal failure.

    02:25 Now when we talk about the pH you've got blue pillow, you've got red pillows, What does that all mean? And that's just to help you think about the couch as a continuum.

    02:35 So normal pH in the middle is 7.35 to 7.45.

    02:40 You might even want to write that in on your notes.

    02:43 If the patient's pH the numbers are getting higher, right? You're moving toward that blue pillow, there inching towards 7.45 or beyond, the pH of their blood is becoming more alkalotic.

    02:56 If their pH of their blood and remember we get this from an arterial blood gas or an ABG if it's getting lower, it's moving towards 7.35 and even lower the pH of the blood is becoming more acidotic.

    03:11 What we're talking about today with DKA, is definitely metabolic acidosis as is renal failure.

    03:19 In fact, these are the two most common causes of metabolic acidosis that you're likely to see in your career.

    03:26 So you got this solid metabolic acidosis is no bueno.

    03:31 It is not good really hard on your body.

    03:35 DKA and renal failure are two ways your body gets thrown off the couch of homeostasis.

    03:43 Now burning fat for fuel can have a price and keep in mind I'm not talking about ketosis.

    03:49 I'm talking about diabetic ketoacidosis for these patients fat is not the best choice for a primary energy sourcing.

    03:57 So for type 1 diabetics, fat is not the most efficient fuel source for them because he without insulin to move glucose into their cells out of the bloodstream and into the cells, the body turns to fat stores for energy.

    04:12 Now we end up with ketones that are a byproduct of fat metabolism.

    04:16 But remember, this level of ketones in their blood is much higher than if someone was on a ketosis diet.

    04:24 Okay, so that's why it's different.

    04:26 I know you keep hearing me repeat that but I want to make sure you're very clear because this is a fairly popular diet plan right now, and I want you to be able to speak intelligently to it.

    04:37 So these ketones come when a type 1 diabetic breaks down fat for energy there a byproduct of fat metabolism and ketones are acid.

    04:47 So ketones are byproducts of fat breaking down.

    04:51 Ketones are acidic, so the more fat the patient's body has to break down for energy as a type 1 diabetic, the more acidic their pH will come.

    05:03 Make sense? That's why somebody with DKA has a much higher level of ketones than someone who's just doing a keto diet.

    05:12 Excessive ketones equals ketoacidosis because ketones are acidic the more of them you have, the more significant the impact on the blood pH.

    05:24 Now excessive ketones also equals severe dehydration.

    05:28 See that pH is turd and it becomes acidic and it puts the patient in metabolic acidosis.

    05:35 So we've got all the ketones there for you just to kind of give you a visual to remember.

    05:39 Hey, the higher ketones get the more dehydrated the patient will get.

    05:44 Now the electrolytes also severely depleted because they're trying to restore balance from this off balance ketosis.

    05:51 So in addition in DKA not just their blood sugar is off but also their electrolytes can be severely off.

    05:58 So we're going to look for imbalances in all of these.

    06:01 You don't need me to read you this list, but take a look at that.

    06:05 These are really life important right there, talking about fluid balance and how the electricity of my heart works and we're balancing the pH of my bloodstream.

    06:14 Yeah.

    06:15 These are all really important in electrolytes and controlling my life and my body health so patients in DKA, we not only deal with keeping their blood sugar normal, but we're also watching for normal values in these electrolytes.

    06:34 Now a patient with ketones in their urine and their blood is most likely experiencing HHS or DKA? See if you can test your knowledge.

    06:43 So if a patient has ketones in their urine in their blood are they most likely experiencing HHS or dka? Okay well, that's a flip a coin kind of answer right.

    06:55 Now I want you to see if you can explain why.

    06:57 Pause the video for a second and see if you can walk back through it we've talked about to support your answer.

    07:04 Okay, welcome back.

    07:07 DKA is a profound absence of insulin, fat is the primary energy source.

    07:13 So ketones are a byproduct of the fat metabolism.

    07:16 So this patient is in DKA.

    07:19 Remember HHS patients have just enough insulin to ward off dka.

    07:26 So good job If you got it, very impressed.

    07:29 If you didn't no problem, just add a special note to yourself and your notes and you will get it next time.

    About the Lecture

    The lecture Diabetic Ketoacidosis: Pathological Processes (Nursing) by Rhonda Lawes, PhD, RN is from the course Diabetes Type 1 and 2: Complications and Symptoms (Nursing).

    Included Quiz Questions

    1. Ketones are produced as a by-product of fat metabolism
    2. Ketones are a by-product of unsuccessful transport of glucose into the cell
    3. Ketones are produced as a result of too much alcohol in the body
    4. Ketones are a by-product of cellular respiration
    1. Metabolic acidosis
    2. Metabolic alkalosis
    3. Respiratory acidosis
    4. Respiratory alkalosis
    1. Ketoacidosis involves dangerously high levels of ketones in the blood, whereas ketosis has a smaller amount of ketones in the blood
    2. Ketoacidosis and ketosis are the same phenomenon
    3. Ketoacidosis occurs in a client who has type 1 diabetes, whereas ketosis affects a client diagnosed with type 2 diabetes
    4. Ketosis occurs when fat is burned for energy and ketoacidosis does not involve burning fat for energy
    1. 7.35-7.45
    2. 7.25-7.35
    3. 7.45-7.55
    4. 7.15-7.25

    Author of lecture Diabetic Ketoacidosis: Pathological Processes (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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