Clinical meaning
Diabetic ketoacidosis (DKA) occurs when absolute or relative insulin deficiency prevents glucose from entering cells, triggering lipolysis and hepatic ketogenesis. Free fatty acids are converted to ketone bodies (beta-hydroxybutyrate, acetoacetate, acetone), causing metabolic acidosis. Hyperglycemia causes osmotic diuresis, leading to severe dehydration and electrolyte losses. The nurse monitors vital signs, fluid intake/output, blood glucose levels, and reports changes to the nurse or provider.
Exam relevance
Risk factors: - Type 1 diabetes mellitus (most common) - Infection or illness (leading precipitant) - Non-adherence with insulin therapy - New-onset diabetes (DKA as initial presentation) - Medication changes (corticosteroids, SGLT2 inhibitors) - Emotional or physical stress - Alcohol or substance use - Pump malfunction in insulin pump users
Diagnostics: - Monitor blood glucose levels every 1-2 hours as ordered - Report blood glucose >250 mg/dL or <70 mg/dL - Monitor strict intake and output and report urine output <30 mL/hr - Report vital sign changes including tachycardia or hypotension - Monitor level of consciousness and report changes - Report fruity breath odor or Kussmaul respirations - Monitor IV fluid infusion rate as ordered