Curing Diabetes

During acute DKA, the patient probably can’t grasp educational information very well, so don’t overwhelm her or her family with information right away. Keep your explanations simple and brief; you may have to repeat them several times. Explain care little by little, as you provide it. Tell her why it’s important to replace fluids and electrolytes, administer insulin, and continuously monitor vital signs, intake and output, and blood values. After your patient’s condition stabilizes, provide more information.If DKA is your patient’s first indication that she has diabetes, you may be the first health care provider to teach her about the disease and its management. Remember, your hospital’s certified diabetes educator can supply vital information and psychological support.

Signs and Symptoms

Signs and symptoms usually begin within 24 hours of the insulin deficiency and may persist for several days before the patient seeks medical attention. Eventually, as her level of consciousness decreases and her polyuria, polydipsia, polyphagia, and weakness become intolerable, she or a family member realizes that she’s in crisis.

An acute infection is the most common cause of DKA, so be sure to check for such signs and symptoms as fever, purulent drainage from wounds, tenderness, and localized erythema. Also, check for signs of systemic infection, including urinary tract, pulmonary, and gastrointestinal (GI) infections.

DKA affects the GI system in many ways. At first, as the cellular fuel supply diminishes, hyperglycemia may cause hunger. As dehydration sets in and DKA progresses, the patient experiences anorexia, nausea, vomiting, and abdominal pain. Profound dehydration may lead to constipation. During an abdominal examination, you may note diminished or absent bowel sounds and abdominal tenderness.

The extreme dehydration and hypovolemia that result from DKA cause tachycardia, orthostatic hypotension, dry mucous membranes, poor skin turgor, and flushed, dry skin. The patient reports weakness and fatigue. And as her condition declines, so does her level of consciousness. Typically, she becomes confused, stuporous, and eventually comatose.

When electrolytes, such as potassium, are lost along with fluids, the patient begins to develop signs and symptoms of an electrolyte imbalance, such as hypokalemia. At first, she experiences general malaise and fatigue along with muscle weakness. Eventually, as the potassium level sinks, she develops flaccid muscle paralysis and arrhythmias.

As ketosis sets in, the body tries to rid itself of excess carbonic acid through Kussmaul’s respirations. You may note a fruity acetone odor-a sure sign of ketosis-on the patient’s breath. As the kidneys filter ketones, ketonuria develops.

Filed under: Acute Complication