Diabetic ketoacidosis (DKA) & hyperglycemic-Hyperosmolar Nonketotoc synd. (HHNS)

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Diabetic ketoacidosis (DKA) is:

hyperglycemia >300 mg/dL - breakdown of body fat for energy - acummulation of ketones in blood and urine. Rapid onset.

Hyperglycemic-hyperosmolar nonketotic syndrome (HHNS) is:

hyperglycemia >600 mg/dL. - dehydration - absence of ketosis. Onset in several days.

Priority interventions for both DKA and HHNS:

Administration of FLUIDS and INSULIN

DKA & HHNS result from sever HYPERglycemia from:

NOT enough insulin (new onset DM, lack of comliance DM treatment) and INCREASE NEED for insulin (stress, illness, infection, surgery, trauma)

HHNS: ketone levels:

serum: absent / urine: absent

DKA: ketone levels:

serum: present / urine: present

HHNS: serum osmolarity:

VERY high

DKA: serum osmolarity:

high

HHNS: serum pH (ABG)

Absence of acidosis

DKA: serum pH (ABG)

Metabolic acidosis w/respiratory compensation (kussmaul respirations)

DKA: serum glucose levels

> 300 mg/dL

HHNS: serum glucose levels

> 600 mg/dL

signs & symptoms for both:

3P's - CHANGE MENTAL STATUS - signs of DEHYDRATION - kussmaul respirations (rapid and deep) - fruity breath (DKA/met.acid) -nausea / abd.pain (DKA) - seizures and revers.palarysis (HHNS)

Priority intervention:

isotonic fluid replacement. Monitor fluid excess.

Nursing intervention: Always...:

treat underlying cause

nursing intervention - insulin

administer IV regular insulin (75 to 150 decrease) monitor level hourly.

nur. intervention - potassium

monitor serum potassium level. With insulin potassium shift into cells. Monitor for hypokalemia.

COMPLICATIONS: Rapid onset of hypoglycemia lead to:

hypokalemia, cerebral edema, fluid volume excess.

COMPLICATIONS: Renal failure:

hourly output < 30ml/hr - monitor hydration and renal function (I & O, creatinite levels)

COMPLICATIONS: thromboembolism:

secondary to dehydration

Older adult with DM:

use bracelet - monitor blood G q 1-4hr when ill - do not skip insulin when ill - hydrate/diminished thirst - mental status? help? - changes in cardiac & pulmonary age diminished function > risk of fluid overload.

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