Content area
Full text
Summary
Diabetic ketoacidosis is a common life-threatening complication, which usually occurs in patients with type 1 diabetes, but it may also occur in those with type 2 diabetes during severe concurrent illness, such as sepsis, myocardial infarction or corticosteroid treatment. This article provides an overview of the diagnosis, pathophysiology and management of diabetic ketoacidosis. The differential diagnosis and treatment of hyperosmolar non-ketotic coma is also discussed, as is the nurse's role in promoting and providing health education to patients with diabetic ketoacidosis.
Keywords
Blood glucose, diabetes, diabetic ketoacidosis, insulin
These keywords are based on subject headings from the British Nursing Index. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.co.uk. For related articles visit our online archive and search using the keywords.
Aims and intended learning outcomes
This article aims to update nurses on the latest guidelines on treating diabetic ketoacidosis. It outlines the pathophysiology of the condition, the aims of treatment, and the differential diagnosis of hyperosmolar non-ketoticcoma and diabetic ketoacidosis. After reading this article and completing the rime out activities you should be able to:
* Recognise the signs and symptoms of diabetic ketoacidosis.
* Understand the need for maintaining strict fluid balance and accurate blood glucose estimation, with clear documentation of all observations.
* Document and report any deterioration in the patient's condition.
* Administer fluids and insulin as prescribed, accurately recording insulin dose per hour.
* Educate patients with type 1 diabetes on how to prevent diabetic ketoacidosis during concurrent illness or infection.
Time out 1
List the signs and symptoms of hyperglycaemia What signs and symptoms indicate progression to diabetic ketoacidosis?
Diagnosis
Alberti (1974) defined diabetic ketoacidosis as 'severe uncontrolled diabetes requiring emergency treatment with insulin and emergency fluids with a blood ketone body (acetoacetate and 3-hydroxybutyrate) concentration of greater than 5 mmol/C. Diagnosis is usually straightforward and symptoms include polyuria and polydipsia, as a result of hyperglycaemia, vomiting, abdominal pain and shortness of breath (Savage and KiI vert 2006). Signs are non-specific and relate to dehydration and acidosis, including tachycardia, hypotension, hyperventilation (Kussmaul breathing), the smell of ketones on the breath and drowsiness or coma. Not...