Definition
DKA is a life threatening diabetes complications, results from absence ( or)
insufficient amount of insulin, lack of insulin inhibits the ability of glucose enter the cells for utilization results of liver rapidly breaks down fat into ketones leads to overproduction of ketones.
Endocrinology medical coding use of specific ICD - 10 code document the diabetic ketoacidosis
Etiology of DKA ( why do overproduction of ketones)
1.Raise in insulin resistance due to
-stress
-Alcohol
-Inborn metabolic error
-Infection
2.Impaired insulin activity
-During diabetic insufficient secretions of insulin it's leads to interruption of insulin delivered to the patient
3.pregnancy
4.Fasting
5.Prolonged exercises
Clinical Manifestations
1.Rapid breathing
2.acetone breath odor
3.polyurea
4.Polydipsia
5.Fatigue
6.abdominal pain
7.anorexia
8.nausea
9.vomiting
In addition the patient may experience blurred vision, weakness, and headache
Pathophysiology of DKA
Diagnosis
1.Physical examination
2.urine analysis ( ketones in a sample of urine)
3.Blood sugar level vary between 300 and 800 mg/dL
4.Blood electrolytes
5.Arterial blood gas analysis
6.Routine chest x Ray
7.Electrocardiogram
- Correcting dehydration
-electrolyte loss correction
-acidosis correction
Treatment guidelines
Dehydration
- Rehydration is important for maintaining tissue perfusion,fluid replacement therapy enhances the excretion of excessive glucose by the kidneys
- The patient may need 6 to 10 L of IV fluid to replace fluid losses caused by polyuriya,hyperventilation, diarrhoea,vomiting
-Monitoring of fluid volume status involve frequent measurements of vitals signs
-Pulse
-Blood pressure
-Heart rate
-lung assessment
-Monitoring for signs of fluid overload especially older people, have renal impairment, or risk of heart failure
Restoring Electrolytes
Major electrolyte of concern during treatment of DKA is potassium, initially plasma concentration of potassium may be low,normal, or high, Therefore , the serum potassium level must be monitored frequently,in DKA affect the potassium concentration by rehydration,
-Rehydration also leads to increase urinary excretion of potassium
-Insulin administration enhances the movement of potassium from extracellular fluid into the cells
-Timely potassium replacement is vital role to avoid dysrhythmias 40mEq/hour needed for several hours
-ECG and laboratory measurements need first 8 hours of treatment.
Reversing acidosis
ketone bodies (acids) accumulate results of fat breakdown in DKA acidosis reversed with insulin
- insulin inhibits fat breakdown,thereby ending ketones production
-Insulin infused by slow IV (5unit/hour), hourly blood glucose level must be monitored
-IV fluid solution with higher concentration of glucose (NS, DNS) are administered when blood glucose levels reach 250 to 300 Ml/dL to avoid too rapid drop in the blood glucose level during treatment
-Insulin must be infused continuously until subcutaneous administration of insulin can be resumed.
Complications
1.Infection
2.Dehydration
3.Hyperkalemia
4.Stroke
5.Myocardial infraction
6.Coma
Patient Education ( Guidelines to follow periods of illness)
- Take oral Antidiabetic agent as usual
-Test glucose and urine ketones 3 to 4 hours
- if u cannot follow usual meal plan, substitute soft foods ( 1 cup cream soup 1/2 cup custard) 6 to 8 times /day
-Report nausea, vomiting and diarrhea to health care provider
- if u unable to retain oral fluid, may require hospitalization.
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