Patient with DKA
When treating a patient with DKA, it is important to look at his medical records to see if they have had the past illness. This will include symptoms and signs of precipitating causes and cerebrovascular accidents. Their history like past DKA and normal diabetic control. Their social history like substance and alcohol abuse. Lastly, their physical examinations which will be focused for looking for diagnosis i.e. dehydration, breathing and other acute pain and trauma. Laboratory values may show electrolyte imbalances, particularly early stages of hyperkalemia. The body attempts to correct acidosis during DKA in exchange for potassium by transferring hydrogen ions into the intracellular space, which moves in the extracellular space. The level of potassium increases with the absence of an intracellular glucose energy source failure of active transport. Administering insulin, reducing the volume and correcting acidosis can re-version potassium to cells, which may lead to hypokalemia. Each 1 to 2 hours the patient is Monitored and IV given to blood glucose and electrolytes. As requested, potassium supplements when the potassium serum level falls below 5.3 mEq / L (Kitabchi, 2016).
Insulin is generally provided as an I.V. Corrected infusion following hypokalemia. Know the usual concentration of your hospital. Be ready every 1 to 2 hours to monitor the blood glucose of the patient and change infusion according to prescription or hospital procedure. Typically, IV decreases to around 250 mg / dL when the blood glucose is reduced. A solution containing dextrose would be modified. In order to stop insulin infusion, the patient can begin subcutaneous insulin injections, depending on the protocol of your hospital.
Substitution of the volume is critical, as most DKA patients are dehydrated. First, prescribe 0.9% solution of sodium chloride and 0.45% solution of sodium chloride. Wait for one or more litres of fluid to be given each hour during the first hours. To measure fluid overload, monitor patient’s vital signs, sodium level of the serum, breath sonorous and urine production. Infection and insulin therapy are common etiologies of DKA. After recognition and management of the underlying cause, inform and refer the patient as appropriate. For an 85-year widow, it will be prudent to teach them to call their caretakers when they get ill and to remind them of the importance of monitoring and adjusting their insulin in case of heavy blood glucose.
References
Kitabchi AE, (2016). Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2016; 29(12):2739–2748.
Clinical Questions, PICO & Study Designs: Formulating a Well Built Clinical Question. Dahlgren Memorial Library/ Georgetown University Medical Center. http://researchguides.dml.georgetown.edu/ebmclinicalquestions. Updated February 3, 2015. Accessed May 2020.