Initial diagnosis For Patient 1
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. Pathophysiologic Explanations
Diabetic ketoacidosis (DK) normally has a characteristic of a bicarbonate level of less than 18mEq/L, a hyperglycemia of above 250 mg/dL, and high pH’s of 7.3 because of ketonuria and ketonemia (Kitabchi et al., 2013). …show more content…
The situation forces the liver to release more glucose than necessary. Therefore, the primary treatment for this patient will be insulin and intravenous fluid. Depending on the severity of the condition, the patient will need an insulin injection through the skin or intravenously as directed by the physician (Bialo et al., 2015). Moreover, as part of the plan to manage the disease, there must be the immediate replacement of the lost fluid depending on the level of dehydration in the patient. There must also be the replacement of electrolytes while trying to suppress the production of ketone and high blood sugars using insulin. Likewise, reliant on the level of the stability of the patient after the initial treatment, the doctor might recommend the patient to be in the ICU or general ward for scrutiny only. The admission will provide the nurse with an opportunity to observe the high the level of blood sugars, electrolytes, and changes of ketones in a matter of
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“Diabetes is a silent killer” (Demille 2005, p.5). It is a metabolic disorder that can result in impaired quality of life and serious complications. This study aims to understand the case of Mr. Skyler Hanson who is newly diagnosed with Diabetes Mellitus Type 1 that leads to diabetic ketoacidosis which was confirmed by the presence of moderate to high ketones in the urine and a high blood glucose level. It was noted that he has a history of fatigue, headache, abdominal pain, nausea and frequent urination. Furthermore, it was disclosed that he has difficulty in adjusting to his diagnosis and he occasionally missed administration of insulin dose when socialising. Subsequently, he was admitted in the Critical Care Unit for rehydration,
Diabetes Mellitus is a growing issue for health care providers internationally. The World Health organization estimated in 2013 there were 347 Million diabetics worldwide, predicting that Diabetes will be the 7th leading cause of death by 2030 (WHO, 2013). In both type 1 and type 2 diabetes Mellitus, factors such as poor compliance with diet and medication, infection, acute medical or surgical illness or trauma can lead to poor glycaemic control, precipitating a hyperglycaemic emergency such as Diabetic Ketoacidosis (DKA) (Scobie & Samaras, 2009). In Type 2 Diabetes, another equally dangerous
DKA is presented with three major physiological disturbances which are hyperosmolality due to hyperglycemia, metabolic acidosis because of the buildup of ketoacids, and hypovalemia from osmotic diuresis. Diabetic ketoacidosis is caused by a profound deficiency of insulin, its most likely occur in people with type 1 diabetes, inadequate insulin dosage, poor self management, undiagnosed type 1 diabetes, illnesses and infections. In type 1
At Yale New Haven on the medicine floor SLA 4, the nurse manager identified the need of education on both the hyperglycemia and diabetic ketoacidosis protocols. The nurses and doctors were not aware of the steps outlined in the protocol that needed to be followed. There have been several incidents across the hospital of orders not being correctly prescribed by physicians and nurses following through with these incorrect orders, therefore seriously effecting patient outcomes. Specifically on SLA 4 there was a recent incidence of a patient coming off of an
Diabetic ketoacidosis is considered to be one of the most life threatening complications for Type 1 diabetics. Along with it being the most common cause of death in Type 1 diabetics under the age of 40 (Mills & Stamper, 2014). Diabetic ketoacidosis, also known as DKA, is when there are consistently high levels of glucose in the blood and not enough insulin to allow the body to function properly. The body then begins to breakdown body tissue in order to create energy in lieu of glucose. Acidic ketones begin to build up in the body and become toxic (Mills & Stamper, 2014). The amount of patients that are admitted to the hospital for a DKA episode are staggering, approximately 8,400 people were admitted from the span of April 2010 to March 2011.
Upon arrival to the emergency department Kristin complains of acute abdominal pain lasting three days with an 8/10 on the standard pain scale which indicates that some organ or organs in Kristin’s abdomen are not properly functioning. Her very high ranking of pain indicates to the nurse that she is in excruciating amount of pain and is very uncomfortable because something is wrong in her abdomen. Secondly, Kristin’s weight gain despite of lack of appetite indicates there is an issue. Typically, with decreased in appetites, patients will lose weight because they are not eating enough calories. Following this statement her glucose fasting levels were tested and came back at 105 mg/dL which is in the normal range for females according to Mayo Clinic. Following her initial assessment, the physicians want to run more tests to diagnose her symptoms. Kristin’s
Classic symptoms of diabetes usually presented with newly diagnosed diabetics are: hyperglycaemia, polyuria, polydipsia, polyphagia, fatigue, blurred vision, headaches, and unexplained weight loss. Ketone bodies are found in the urine, this abnormal finding occurs when fatty acid by-products (acetones) are excreted in the urine. The ketones are present from a lack of the insulin hormone used to metabolize fats and carbohydrates. Diabetic ketoacidosis (DKA) is a life-threatening complication which results from minimal useful insulin hormone in the body, hypoglycaemia, or insufficient food intake (American Diabetes Association, 2008).
The concentration of β-hydroxybutyrate within the blood, as it is confirmation of ketoacidosis. The correction of hyperglycaemia and the suppression of ketone production can be reduced with insulin therapy.
Diabetic Ketoacidosis is a condition of Insulin deficiency and hyperglycaemia resulting in metabolic acidosis and severe osmotic diuresis.
Usually caused by autoimmune destruction of pancreatic beta cells, which produce and secrete insulin. By time symptoms develop, the damage to beta cells has progressed so far that insulin must be supplied exogenously, most often by injections. Reason for autoimmune attack is usually unknown, environmental toxins can be factors. People often have genetic susceptibility for disorder and are at increased risk of developing autoimmune diseases. Type-I usually develops during childhood and symptoms may appear abruptly. Classic symptoms are polyuria, polydipsia, and weakness. Acidosis due to excessive production of ketone bodies, ketoacidosis, is sometimes the first sign of diabetes. Blood test that detect antibodies to insulin, pancreatic islet cells, and pancreatic enzymes can confirm diagnosis and help predict development of
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 (DKA) is a disease state, most often seen in individuals with Type I Diabetes. While it most often results from uncontrolled insulin levels, young children can often present in diabetic ketoacidosis as the initial presentation of undiagnosed type I Diabetes. The major symptoms of Type I Diabetes, polydipsia, polyphagia, and polyuria, are often subtle and can be normal in growing children (Urden, Stacy & Lough, 2014; Wilson, 2012). Unless alert to the symptoms of Diabetes they can often be overlooked until severe enough to warrant immediate medical attention.
This paper will explore the history and hospital course of Mr. Z., a 23 year old Caucasian male who was admitted on October 11, 2016 to Massachusetts General Hospital for treatment of diabetic ketoacidosis (DKA) and new onset type 1 diabetes mellitus. DKA is an emergency situation that results in 100,000 hospitalizations in the US yearly, a 9% mortality rate, and treatments of reportedly 1 billion dollars per year (Katsilambros, Kanaka-Gantenbein, Liatis, Makrilakis, & Tentolouris, 2011). Presenting to the emergency room with DKA is the first manifestation of type 1 diabetes in 30% of cases (Katsilambros et al., 2011). This paper will examine Mr. Z.’s case presentation, pertinent medical history, diagnosis formulation, hospital management, intensive review of his medications, and discussion.
Metabolic acidosis happens when the chemical balance of acids and bases in your blood gets thrown off. This can be triggered when the body; is producing too much acid, isn't getting rid of enough acid or doesn't have enough of a base to offset a normal amount of acid. When any of these occur, chemical reactions and processes in your body don't work right. Diabetics can suffer from a Metabolic acidosis know as Diabetic Ketoacidosis. Diabetic Ketoacidosis (DKA) is a life-threatening condition that develops when cells in the body are incapable to get the sugar (glucose) they need for energy because there is not adequate insulin. When the sugar cannot enter into the cells, it stays in the blood. The kidneys filter some of the sugar from the blood
Diabetes Mellitus is a chronic disease that affects approximately 1.7 million Australians (Diabetes Australia, 2015). It affects the entire body and can have a significant impact on life (Diabetes Australia, 2015). Complications of diabetes such as hyperglycaemic emergencies, present to the emergency department on a weekly basis (Donahey & Folse, 2012). The most prominent being diabetic ketoacidosis (DKA) (Donahey & Folse, 2012). Hospitals within Sydney Local Health District (SLHD) have customised practice guidelines for the management of adults presenting with DKA. The aim of this paper is to review the evidence on the management of DKA and to determine if it replicates the current objectives of the guidelines being used.