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Regulatory: Diabetic Ketoacidosis - Coggle Diagram
Regulatory: Diabetic Ketoacidosis
Pathogenesis
Ketones
(acidic) are generated as a byproduct of lipolysis - throwing off pH balance causing (
ketoacidosis
)
The excessive glucose in the bloodstream makes the bloodstream hypertonic, drawing fluid from ECF (
osmotic diuresis
)
Lipolysis
occurs (fat break down) as one form of gluconeogenesis
Osmotic diuresis causes massive fluid shift and F/E imbalance as the body flushes fluids and electrolytes follow H2O
Cell signaling increases glucose by increasing hepatic glucose released into blood and triggering
gluconeogenesis
processes
Dehydration occurs
Cells deficient in glucose signal for more glucose
Renal function become impaired
Absolute insulin deficiency
(DMT1) keels glucose from entering most cells
Symptoms
Diuresis
Kussmaul breathing
Polydipsia
Fruity breath (ketones on breath)
Polyuria
N/V/D
Changes in mental status
LOC changes
Blurred vision
Weight loss
Tachycardia
Hypotension
Risks
Type 1 Diabetes Mellitis (DMT1)
Missing insulin dosages and non-adherence to DM treatment plan
Recent illness
Stress
Undiagnosed DM
Corticosteroids
Pregnancy
Socioeconomic factors
Collaborative treatment
Monitor I/O
Admin sodium bicarbonate to correct metabolic acidosis
Monitor K+ and ECG
Educate on effects of illness and "sick day" plan, s/s of hyperglycemia
Correct BG slowly, per algorithm with IV reg insulin
K+ replacement protocol
Fluid resuscitation
NPO
Complications
Cerebral edema
Pulmonary edema
Hypovolemia
Coma
AKI
Death
Arrhythmias
Stroke
Diagnostics/labs
GFR, Creatinine, BUN
CMP for K+ and Na+
ABG (monitor pH and bicarb)
Serum osmolality
BG levels
UA for ketones and glucose in urine
ECG, K+ imbalance can cause arrhythmia