Case Study Based On Diabetic Ketoacidosis

Further complicating the diagnosis and treatment can be a mixed picture of both HHS and DKA. This occurs in both type 1 diabetes and Type 2 diabetes. In this case treatment is balanced between correcting the metabolic acidosis and lowering the osmolality of the blood. (Kearney T. & Dang, C., 2007)

Diabetic ketoacidosis (DKA) is an acute life threatening complication of diabetes. Although DKA is most common in patients with type 1 diabetes, it can also occur in those with type 2 as seen in our patient from the case study. DKA develops when there is an absolute or relative deficiency of insulin and an increase in the levels of insulin counter regulation (Huether & McCane, 2104). DKA is characterized hyperglycemia, ketoacidosis, and ketonuria.

Diabetic Ketoacidosis (DKA) is a serious disease with complications that may have fatal results in some cases. DKA is defined as an insulin deficiency that occurs when glucose fails to enter insulin into muscles such as: liver and adipose tissue. When there is an accumulation of ketones, it leads to metabolic acidosis which causes nausea and vomiting, as a result fluid and electrolytes are loss (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypolglycemia, and Acute Pancreatitis.

As we discuss acid and bases along with pH balance in blood a term that came to mind was Diabetic Ketoacidosis (DKA). This is a term that I have heard numerous times but didn’t not understand the meaning or cause. The term is commonly associated with diabetes but can also be associated with extreme exercise, low carbohydrate diets and eating disorders

A sixteen-year-old boy was admitted through the emergency room presenting with difficulty breathing, abdominal pain, dry mouth, frequent urination, and fruity odor on breath. Initially, diabetic ketoacidosis comes to mind, but further labs are ordered to

Diabetic Ketoacidosis, also known as DKA, is one of the leading complications related to hyperglycemia in a patient who has Type 1 Diabetes. According to the CDC, “In 2014, 168,000 patients were discharged from the hospital due to DKA”. (INSERT IN TEXT CITATION FROM CDC WEBSITE). Diabetic Ketoacidosis is a combination of elevated blood sugar, ketosis, metabolic acidosis, dehydration and electrolyte imbalance. DKA is considered a life-threatening emergency. It is important as the nurse to be able to recognize the signs and symptoms and intervene early.

Despite being diagnosed two years ago and having a toe amputation at the same time, the patient is not compliant to her medications and has been substituting cinnamon tea for insulin. A client’s readiness for learning should always be assessed, but even more so when she is elderly and Hispanic, both factors known for increased obstinacy. A patient who is not ready to learn or to understand will not let the facts affect her actions and will continue her non-compliance. Similarly, the patient should be educated on injection sites. Insulin can be injected in numerous places, including but not limited to the abdomen, the outer arm, and the buttocks. The nurse should use the outer arm, or buttocks while the patient is admitted since the patient is not able to reach these. The patient is then able to use the thigh and the abdomen at home. The differing of sites is to prevent firm lumps or fat deposits, which alter the way insulin is absorbed, from forming. Furthermore, the patient’s activity level should be increased as tolerated. Due to her age, the client may not be able to do much exercise; however, activity should be a part of her day. Studies have shown that as little as 50 minutes of walking for three days a week have significant long and short term effects, even on the elderly. Included in these effects are increased daily physical activity, physical strength, and energy consumption as well as decreased fasting blood glucose and A1C levels (Sung, 438). Similarly, increased activity will promote weight loss, which will also be helpful in the long term. Along the same lines, the patient must understand the importance of balancing exercise with food intake and insulin injections. The more the body has to work, the more glucose it will use up, which in turn will then use more insulin. By balancing exercise with intake, the elderly patient will be able to control sudden life-threatening increases

Diabetic Ketoacidosis (DKA) is an acute complication of uncontrolled glucose levels characterized by reduced levels of insulin and presence of ketones. It is a medical emergency and results can be detrimental if left untreated. DKA is commonly seen in patients with type 1 diabetes mellitus (type 1 DM). However, critically ill patients with type 2 diabetes mellitus (type 2 DM) such as trauma, surgery or infection, are also at risk for DKA (Ignatavicius & Workman, 2013). Patients with type 1 DM are predisposed to DKA if their underlying conditions are not diagnosed early and in some cases, they may experience similar signs and symptoms without actually developing DKA. Comorbidities involving parts of

The patient in this study was repeatedly seen in the unexpected emergency department so they local hospital. These trips to the hospital caused several hospital admissions for verified diabetic ketoacidosis. These admissions were inevitably the result of voluntarily not using any dosages of her insulin, to which she at some point confessed.

In Ketoacidosis the body is making too many ketones due to fats being burned for absent carbohydrates as source of energy, excessive amount of fats in the body become acidic creating the ketones. Possible cause are diabetics not receiving proper insulin and hydration, excessive alcohol drinking with low po intake, as well as anoxia. The patient have the following signs and symptoms tachypnea, tachycardia, HA, confusion, tired or weakness, loss in appetite, and or N/V. Treatment is to correct the imbalance or the underlying cause of the imbalance ie hydration fluids, Insulin

Two mechanisms, insulin resistance and decreased insulin secretion, are vital functions that lead to the development of Type 2 Diabetes. Insulin resistance is the effect that insulin has on insulin-sensitive tissues and their response to the insulin (McCance and Huether, 2010). Abnormality of the insulin molecule, high amounts of insulin antagonists, down-regulation of the insulin receptors, decreased/abnormal activation of postreceptor kinases, and alteration of glucose transporter proteins all lead to defects of the insulin molecule itself (McCance and Huether, 2010). Because the patient is obese, he is at risk for hyperinsulinemia and decreased insulin receptor density. When compensatory hyperinsulinemia occurs, the client may not begin to see the manifestations of Type 2 Diabetes for several years (McCance and Huether, 2010).

This was basically unbelievable for him, as he attempted various medicines keeping in mind the end goal to acquire the same results. Therefore, he quit taking insulin as he trusted that his new eating routine can't raise the sugar levels. For any case, he planned to backtrack to the same insulin treatment in the event that they increment. However, nothing changed, his glucose levels stayed stable and he began getting thinner.

As the insulin deficiency continues, the blood glucose level increases. In response to which kidney filters the excess glucose out of the blood into the urine along with large amount of water. Unless the large amount of water is consumed, the kidneys cannot keep up the demand of removing the glucose from the blood stream and diluted it sufficiently in urine. As a result, the blood become much more concentrated than the normal. This condition is called hyperosmolarity. Hyerosmolarity pulls water out of the body tissues into the blood stream causing severe dehydration which may leads to hyperosmolar hyperglycemic nonketotic syndrome. Neurological syndromes such as comma can

After undertaking a thorough primary and secondary assessment, the provisional diagnosis for this patient is alcoholic ketoacidosis (Queensland Ambulance Service, 2011). Yanagawa, Hirano, Takemoto, Takei, Ito & Iba (2012) states that alcoholic ketoacidosis is an acute metabolic acidosis, characterised by dehydration; depleted liver glycogen stores; an elevated nicotinamide adenine dinucleotide (NAD+) to nicotinamide adenine dinucleotide (NADH) ratio; and an increased production of free fatty acids which results in an increased production of ketone bodies (Ansstas, Robinson, Rubinchik, & Schade, 2014; Laoteppitaks & Wiener, 2013; Unbound Medicine, 2014). Yanagawa, et al. (2012) proposes that alcoholic ketoacidosis is caused by a recent alcohol

The initial diagnosis is Diabetic ketoacidosis (DK) adding the symtoms of type 1 diabetes ( hyperglycemia). Once the patient arrives at the hospital, the initial interventions will focus on an aggressive management of glucose, electrolyte, and the volume of blood of the patient. A finger stick and Ketone test will be the initial action to undertake, because it will first confirm the existence of a diabetes condition (Baillie, 2012). If the level of ketone is high during the test, then there is a presence of ketoacidosis.