INTRODUCTION

DIABETIC KETOACIDOSIS (DKA)

Diabetic Ketoacidosis is a condition in which the body cells are unable to get glucose for energy due to low or no insulin secretion by the pancreas. Thus for energy requirement the body system start breakdown stored fat for energy, break down of fat produces toxic acid called ketones. Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in diabetic patients. It mostly happens in those with type 1 diabetes and at many cases type-1 diabetes is first diagnosed after a DKA episode. It can also occur in those with type 2 diabetes under certain circumstances. DKA episode occurs when there is an absolute shortage of insulin; in response the body switches to burn fatty acids and producing acidic ketones that cause most of the ketoacidosis symptoms and complications. In DKA, there is severe alteration of carbohydrate, protein, and lipid metabolism. In general, the body is shifted into a major catabolic state with breakdown of glycogen stores, hydrolysis of triglycerides from adipose tissues and mobilization of aminoacids from muscle. The released triglycerides and amino acids from the peripheral tissues will be the substrates for the production of glucose and ketone bodies by the liver. Hyperglycemia and ketone bodies production play central roles in developing this metabolic decompensation. Worldwide prevalence rate according to World health Organization 347 million people worldwide have diabetes. More than 80% of diabetes deaths occur in low- and middle-income countries.In the Philippines, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey) study is 4.8%. NSO (National Statistics Office) projects that there would be 74 million adult Filipinos in 2010. Therefore, there could be 3.6 million Filipinos who have diagnosed diabetes. Diabetic ketoacidosis can lead to rapid breathing, flushing, fruity-smelling breath, nausea, vomiting, pain,fatigue, headache, and muscle stiffness. In severe cases, ketoacidosis can lead to a slowing of mental activity that can progress to a coma. The consequences of ketoacidosis can be severe, even life threatening, but modern treatments are usually very effective at preventing serious complications if treatment is obtained early.

Symptoms of Diabetic Ketoacidosis:

Symptoms of diabetic ketoacidosis include symptoms related to both the digestive system and nervous system, both of which are affected by the buildup of toxic ketones.

Digestive symptoms of diabetic ketoacidosis Digestive symptoms of diabetic ketoacidosis are related to the use of fats instead

of glucose for energy and the bodys attempts to compensate for the lack of usable glucose. These symptoms include:

Abdominal pain Dry mouth Loss of appetite Nausea with or without vomiting Stomach pain Nervous system symptoms of diabetic ketoacidosis Ketones are poisonous to the brain and can cause a variety of serious symptoms including:

Difficulty with memory, thinking, talking, comprehension, writing or reading Fatigue Feeling very thirsty Headache

Other symptoms of diabetic ketoacidosis Diabetic ketoacidosis may cause a variety of other symptoms, such as: Body aches Difficulty breathing Dry skin Frequent urination Rapid breathing (tachypnea) or shortness of breath

Risk Factors for DKA:

A number of factors increase the risk of developing diabetic ketoacidosis in patients with diabetes, especially type 1 diabetes, a chronic condition in which the pancreas produces too little or no insulin. Not all people with risk factors will get diabetic ketoacidosis. Risk factors for diabetic ketoacidosis include:

African American or Hispanic ethnicity Heart attack (myocardial infarction) Serious illness Serious infections and gangrene Surgery Traumatic injury

Test and Diagnosis:

Blood tests will be ordered to document the levels of sugar, potassium, sodium, and other electrolytes. Ketone level and kidney function tests along with a blood gassample (to assess the blood acid level, or pH) are also commonly performed. Other tests may be used to check for conditions that may have triggered the diabetic ketoacidosis, based on the history and physical examination findings. These may include chest X-ray, electrocardiogram (ECG), urine analysis, and possibly a CT scan of the brain.

Treatment
The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids lost through urination and vomiting. Most of the time, you will need to go to the hospital, where the following will be done:

Insulin replacement Fluid and electrolyte replacement The cause of the condition (such as infection) will be found and treated

Objectives
General Objectives:
This study aims to learn new clinical skills as wells as sharpen our current clinical skills required in the management of the patient with Diabetic ketoacidosis.

Specific Objectives:
After completing the case study, the student nurses should be able to: Define Diabetic Ketoacidosis Discuss the incidence and prevalence of DKA Discuss the appropriate nursing and medical management Discuss the pathophysiology of DKA Describe the pathophysiology associated with Diabetic ketoacidosis