DKA case study

DKA case study - Introduction

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1. Describe the pathophysiologic changes in DKA. DKA is a life-threatening complication of type 1 diabetes mellitus that develops when a severe insulin deficiency occurs. The main clinical manifestations include hyperglycemia, dehydration, ketosis, and acidosis. a. Why do blood glucose levels increase? Blood glucose levels increase because there is a decrease in insulin production, which blocks the glucose from entering the cell. b. What are commonly seen blood glucose levels? In DKA, serum glucose levels are usually greater than 300mg/dL c. What fluid and electrolytes disturbances commonly occur? Serum Na may be increased. Serum K will be elevated as a result of dehydration and acidosis. Dehydration will occur because polyuria is caused by an osmotic dieresis induced by hyperglycemia. d. What causes the fluid and electrolyte disturbances? Dehydration e. What acid-base disturbances are commonly seen? Serum pH is below 7.35. Metabolic acidosis occurs. Bicarbonate level is below 15mEq/L. f. Why do the acid-base disturbances occur? Metabolic acidosis is due primarily to the accumulation of ketone bodies. Some degree of lactic acidosis exists from hypoperfusion, which also contributes to the acidosis. 2. Describe the medical management of a patient in DKA. a. How is fluid status monitored in the acute stages of DKA? Monitor intake & output. Potassium & Sodium level are increased. Observe skin turgor. b. How is hypovolemia correceted? How rapidly is fluid volume replaced? Why? Isotonic normal saline is necessary as a first line of treatment. 1,000ml in 1 hour. c. How are blood glucose levels monitored? How often? Fingerstick glucose monitor tests are done as needed. If too dehydrated, draw blood hourly. d. How are elevated blood glucose levels corrected? Give insulin.
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This note was uploaded on 10/06/2011 for the course NU 314 taught by Professor Rock during the Spring '11 term at North Alabama.

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DKA case study - Introduction

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