Case Study : Diabetic Ketoacidosis

The Consultation Report dated 12/07/2016, indicated that the claimant presented with uncontrolled type 2 diabetes mellitus. He also had a chronic back pain, arthritis, and a history of diabetic neuropathy. His blood sugar was 800 (critical stage). His blood pressure was 129/62 mmHg. The physical examination revealed mild thyromegaly, a decreased air entry at the base of the lungs, and a decreased peripheral palpable pulse. The exam also revealed loss of hair and chronic ischemic changes. Toe deformity and peripheral deformity were noted. He was on Levemir and Novolog. According to the provider, the claimant was on steroids, which has caused an increased blood sugar level. HBA1c

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

J. J. is a 12-year-old, independent, type 1 diabetic; diagnosed at 5-years-old. Her experience of being diagnosed was a difficult and almost fatal one. It all started when J. J. got a bad ear infection and had an accident, which was extremely abnormal for her. The doctor put her on amoxicillin, and a week later she came down with a rash. J. J.’s mother brought her the doctor, and he thought it was mono. They did a mono test and the results came back negative, however, the doctor was sure it was mono. He told J. J.’s mother to stop giving her the amoxicillin and that the symptoms would subside. They stopped taking the antibiotic, however, J. J. symptoms got worse. She was frequently thirsty, using the restroom often, sleeping a lot, and would complain of stomach pain. J. J.’s mother said, “my ex and I would ask if the doctors were going to test her blood. None of the doctors did” (personal communication, October 26th, 2016). J. J. went to 4 different doctors before she was in some much pain that she couldn’t move and was throwing up; later that day, she was diagnosed in the Ellensburg’s Emergency Room. J. J.’s mother stated, “the ER doctor walk into the room and immediately said she diabetes, and needs to go to children’s now. The doctor said she could smell the ketones on J. J.’s breath.” (personal communication, October 26th 2016). Ketones are substances that the body creates, when it breaks down fat, instead of carbohydrates for energy. Ketones make the blood

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

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).

Diabetes ketoacidosis (DKA) primarily occurs in type 1 diabetes which is characterised by hyperglycaemia, polyuria, polydipsia, hyperventilation and dehydration (Mellitus, 2005).

The problem with Mrs. Brown, is that she is found with Diabetic Ketoacidosis. Diabetic Ketoacidosis is when your body produces high glucose acid in the body. In this case, Mrs. Brown has high blood glucose. Meaning that she is metabolically acidosis. What her body is trying to attempt is to exhale the excessiveness of carbon dioxide in her body. Which having an excess of CO increases her respiratory rate. Mrs. Brown’s kidneys are reabsorbing bicarbonate ions at that very moment but is not enough to fight the

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

Diabetic ketoacidosis is an event which occurs when there is not enough insulin in the body to utilize sufficient amount of glucose needed to provide cells with energy; body then starts to use fatty acids as a fuel, which are converted to ketones in the liver. In healthy people who do not have diabetes, ketone bodies are produced in normal quantities and then successfully used by tissues as energy supply. This state is known as dietary ketosis and it is completely normal and may even provide health benefits. But in those who have diabetes, ketones are produced in enormous quantities and aren't used in full by cells, so they start to build up in the blood. Acids 3-hydroxybutyric acid and acetoacetic acid are produced rapidly causing decrease in buffering capacity of the blood and eventually depleting buffering systems (Manninen, 2004).

Diabetic ketoacidosis (DKA) DKA and hyperosmolar hyperglycemic syndrome (HHS) occurs in 20 % of the elderly who have not previously been diagnosed with diabetes. HHS is more often found in the elderly, being precipitated by an acute illness or drug therapy (Childs, Cypress, & Spollett, 2009). DKA and HHS, are both similar in the aspect for a decrease in the effective concentration of insulin in conjunction with the counter regulatory hormones glucagon, cortisol, growth hormone and epinephrine. However, DKA and HHS differed in the driving force, degree of insulin deficiency, serum glucose levels, pH, serum osmolality and duration of symptoms (Childs, Cypress, & Spollett, 2009).

Sugar is the primary fuel for the cells in the body, and the insulin takes the sugar from the blood and into the cells. When glucose builds

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 lost (Gibbs). There are many complications of diabetic ketoacidosis, some of the most prevalent are: Cerebral Edema, Hypoglycemia, and Acute Pancreatitis.

I am Barbara Ligons your nurse and I will be assisting Dr. Gupta in caring for your daughter Ellen. When Ellen came into the emergency room she was barely conscious. She complained about excessive vomiting, frequent urination, excessive thirst, seeing double, headaches, and feeling really tired for the last two days. From these observations Dr.Gupta suspects a serious diabetic complication called ketoacidosis. Ellen has complained of weight loss of 15lbs in the last month and I do see in her file she has a history of headaches, depression and urinary tract infections which is where bacteria are found in the urine. After reviewing her records I also observed that the last surgeries she has had was the removal of her

Diabetic ketoacidosis is a serious complication of diabetes mellitus that is characterized by an ion gap metabolic acidosis, hyperglycemia, and ketonemia. For diagnosis of diabetic ketoacidosis to be made, a patient's plasma glucose concentration must be above 250 mg/dL, with a pH of less than 7.30, and a bicarbonate level of 18 mEq/L or less.