Diabetic Ketoacidosis | Made easy | DKA | Causes | Pathophysiology |signs & Symptoms | Management

Diabetes mellitus is a metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion.
.
This leads to hyperglycemia, which may result in acute metabolic complications such as
 Diabetic ketoacidosis (DKA) &
 Hyperglycemic hyperosmolar nonketotic syndrome (HHNS).

Diabetic ketoacidosis is characterized by hyperglycemia, ketonemia, and acidemia.DKA is caused by an absence or markedly inadequate amount of insulin.
Causes of Diabetic Ketoacidosis
• Infection: (pneumonia, bacteremia, UTI etc.).drug intoxication
• Side effects of drugs (Steroids),Failed to take insulin
• Vascular occlusion ,Surgical procedures ,Stress
• Pregnancy
Diabetic Ketoacidosis : Pathophysiology
Insulin controls the glucose level in the blood by regulating the production & storage of glucose. In the diabetic state, the cells may stop responding to insulin or the pancreas may stop producing insulin.
Without insulin, the amount of glucose entering the cells is reduced & the liver increases glucose production.—-Hyperglycemia—–Osmotic Diuresis—–Dehydration and marked electrolyte loss.
Another effect of insulin deficiency
Breakdown of fat into FFA & glycerol——–FFA converted into Ketone bodies by the liver——-Accumulation of ketone bodies in the circulation
Metabolic acidosis
Clinical Manifestation of Diabetic Ketoacidosis
• Dehydration: Poor skin turgor, Dry mucous membrane
• Electrolyte imbalance
• Acidotic breathing
• Drowsiness, Restlessness, Stupor, Convulsion
• Cardiac irregularities
• Urine output high or low
Diagnostic Evaluation
• History collection
• Physical Examination : Signs of dehydration
• High blood sugar more than 300-400 mg/dl
• Blood Investigation :
Serum electrolytes: Sodium and potassium levels may be low, normal, or high, depending on the amount of water loss (dehydration).
Elevated BUN and creatinine
• ABG : Metabolic acidosis,Respiratory alkalosis
• Urine infections, Pus cells in urine, Ketone bodies in urine

Diabetic Ketoacidosis : Medical Management
• Rehydration:
• Restoring Electrolytes
• Reversing Acidosis
• Blood sugar control & Restoring vital organ control
Diabetic Ketoacidosis : Nursing Management
• Monitor vital signs ,saturation and Pain score
• Monitor electrolyte status as well as blood glucose levels.
• Monitor urine output and mainatin I/O chart.
• Monitor for dysrhythmias indicating abnormal potassium levels.
• Check the conscious level of patient.
• Administer insulin as per the order.

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A urinary tract infection, or UTI, is an infection in any part of the urinary system — the kidneys, ureters, bladder and urethra.
An infection of the urethra, or urethritis, may cause burning sensation when urinating and cloudy discharge. A bladder infection, or cystitis, may result in pelvic pain, frequent, painful urination, and blood in urine. A kidney infection, or acute pyelonephritis, may cause back pain (possibly only on one side), high fever, chills and nausea.
UTIs typically occur when bacteria enter the urinary tract through the urethra and multiply in the bladder. Most commonly, these bacteria come from the digestive tract through fecal matter. UTIs are more common in women because of their anatomy. Specifically, the short distance from the A to the opening of the urethra and bladder makes it easier for the bacteria from the digestive tract to reach the urinary system. This is why the most common UTIs occur mainly in women and affect the bladder and urethra.
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– Drink plenty of fluids – to flush out bacteria more frequently.
– Wipe from front to back after a bowel movement – this helps prevent bacteria in stools from spreading to the urethra.
– Empty the bladder soon after I to flush bacteria.
– Avoid feminine products such as douches and powders, which could irritate the urethra.
– Avoid diaphragms and spermicides as birth control methods
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This video covers the basic pathophysiology that leads to Diabetic Ketoacidosis using easy-to-follow animations/cartoons. Includes: how insufficient insulin levels lead to hypoglycemia, high urine output and thirst, hypothermia, metabolic acidosis, and cardiac dysthymia.

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