What should you assess in DKA?
Monitor the patient’s vital signs, serum sodium level, breath sounds, and urine output to assess for fluid overload. Etiologies of DKA commonly include infection and inadequate insulin therapy. Once the underlying cause is identified and managed, educate and refer the patient as needed.
What causes DKA?
DKA occurs when blood sugar levels are very high and insulin levels are low. Our bodies need insulin to use the available glucose in the blood. In DKA, glucose can’t get into the cells, so it builds up, resulting in high blood sugar levels.
Can stress cause DKA?
Infection is the most common precipitating cause in most reported series of diabetic ketoacidosis, but stress in any form can lead to metabolic decompensation. Omission of insulin is an unusual cause of ketoacidosis, and in approximately one-quarter of patients no cause can be identified.
When do you add potassium to DKA?
Potassium, bicarbonate, and phosphate therapy If serum potassium decreases to <3.3 mEq/L during DKA treatment, insulin should be stopped and potassium administered intravenously. Small amounts of potassium (20–30 mEq/L) are routinely added to intravenous fluids when serum potassium is between 3.3 and 5.3 mmol/L.
Is sodium high or low in DKA?
Because of the osmotic shift of water, plasma sodium concentrations are usually low or normal in DKA and can be slightly increased in HHS, despite extensive water loss.
Why is serum potassium elevated in DKA?
Insulin promotes potassium entry into cells. When circulating insulin is lacking, as in DKA, potassium moves out of cells, thus raising plasma potassium levels even in the presence of total body potassium deficiency [2,3].
How is hyperkalemia treated in DKA?
Rapid hemodialysis along with intensive insulin therapy can improve hyperkalemia, while fluid infusions may worsen heart failure in patients with ketoacidosis who routinely require hemodialysis.
What causes hyperkalemia in diabetic ketoacidosis?
Patients with diabetes often also have diminished kidney capacity to excrete potassium into urine. The combination of potassium shift out of cells and diminished urine potassium excretion causes hyperkalemia. Another cause of hyperkalemia is tissue destruction, dying cells release potassium into the blood circulation.