Case Study Diabetic Ketoacidosis

The blood glucose level has very limited range for humans to survive and stay healthy. Generally, people are able to remove excess glucose rapidly from the body but this is not the case when they are diagnosed with diabetes and insulin resistant situations. The lack of insulin resistance can also lead to a decrease in glycogen synthesis and storage as it usually converts glucose to energy for cell’s use (Jensen & et al. 2011). When insulin is produced under insulin resistance, the cells are incapable of using them effectively which then leads to high blood sugar level as ketones and ketoacids are produced as an alternative energy source for the body. The rise of ketoacid causes the blood pH acidic and the patient may also be diagnosed with ketoacidosis (Newton & Raskin 2004). There would also be less intake of lipid and more of stored triglycerides as the lipids are effected by the insulin. As the glucose levels increase, the muscle glucose uptake will decrease while the liver glucose production and blood fatty acid concentration will also increase within the body (Lichtenstein & Schwab 2000). Excess glucose within the blood are converted to fat which can lead to Diabetic Dyslipidaemia and furthermore to obesity, hypertension and

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

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

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

Patient G.M. is a four-year-old female from a middle class family living in San Diego. She originally presented with her mother and father to her general practitioner with lethargy and several vomiting episodes in the past few days. Her father stated concern after realizing her frequent urination in the past week. Her vital signs upon initial assessment were HR 140 RR 22 Temperature 102.7 degrees Fahrenheit, BP 70/62, O2 saturation 97%, 32 pounds, and 40 inches tall. Her General practitioner was concerned about type I diabetes and performed a blood sugar check. Upon assessment the monitor read HI, indicating that the level was above 500 and too high for the monitor to read. The doctor informed them she needed immediate treated in the closest pediatric ER due to the potential for diabetic ketoacidosis.

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.

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.

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

The main reasons for mortality among people with DKA are hypokalemia, infection, and circulatory collapse, which all can lead to cerebral edema (Wilson, 2012). In people who have Type 1 diabetes more than 20 percent experience frequent episodes of hyperglycemia and DKA. These reoccurring episodes of DKA can lead to or worsen chronic macrovascular complications of diabetes, such as retinopathy and other eye diseases. It has also been found to be associated with myocardial infarction, congestive heart failure, cerebrovascular accident, gastrointestinal bleeding and undiagnosed diabetes (Wilson, 2012). When a patient present to the emergency department with loss of consciousness along with other symptoms of DKA it is important for the nurses to take urine, sputum, and blood cultures to test for the presence of ketone bodies. An arterial blood gas sample is also important, this is to test for cardiac enzyme and undertake amylase and lipase analyses to be able to identify the causes of DKA (Wilson, 2012). DKA can be diagnosed when there is a urine ketone concentration of at least 3mmol/L, blood glucose of at least 11mmol/L or presence of Type 1 diabetes, and venous blood bicarbonate concentration of no more than 15mmol/L or pH no more than 7.3. Airway, breathing, circulation, and neurological status should be the focus of initial assessment (Wilson,

The goal of treatment for Mr Jones is to lower his high blood sugar level with insulin an hour after the insulin infusion is administrated with the expected outcome of maintaining a blood glucose level in the range of 8.3mmol/l – 10.0mmol/l within 72 hours (JBDS, 2012). Due to this it is vital that Mr Jones’s blood sugar is monitored and regulated frequently (JBDS, 2012). Another goal is to replace his lost body fluids; intravenous fluids will be given to treat dehydration and dehydration status will be assessed every hour by monitoring intake and output, skin turgor and vital signs (JBDS, 2012). Mr. Jones will be able to understand the care that is being given and why it is being given within 30 minutes of diagnosis and he will also be able to express his fears and discuss his needs with nursing staff, which combined with improvements in his blood sugar levels will reduce his anxiety.

            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

In this scenario, according to his blood work results and signs and symptom, Larry went through diabetic ketoacidosis. When there is an increased blood glucose level in DKA, three major syndromes occurs such as electrolyte imbalance, metabolic acidosis and osmotic diuresis.(Mistovich j,2008)

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.