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:
DKA: serum osmolarity:
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)
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)
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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