DKA disease or Diabetic ketoacidosis is a life-threatening disease condition and it occurs because of severe insulin deficiency. DKA disease or Diabetic ketoacidosis is a complication of type 1 diabetes Mellitus. How to identify diabetic ketoacidosis? DKA disease can be identified by the assessment. The main clinical manifestations are fruity odor breath, nausea, abdominal pain, dehydration, electrolyte loss, hyperglycemia (blood glucose level more than 300mg/ dl), ketosis, acidosis, polyuria, polydipsia, weight loss, sunken eyes, lethargy, dry skin, and coma. The reason for DKA disease is inadequate insulin dose, infection, and other stressors.
HOW TO MANAGE DKA DISEASE?
1. Initial step to manage DKA disease is to treat dehydration. For rehydration, infuse iv normal saline as per the doctor’s order. If the blood glucose level reaches 250 mg/dl, start IVF dextrose. The blood glucose level reduction too rapidly can lead to cerebral edema. Water is pulled from the blood to the cerebrospinal fluid and the brain, these cause increased intracranial pressure and cerebral edema.
2. Treat high blood sugar with insulin administration. Always place insulin infusion on an infusion pump. Use short-duration insulin. Also, insulin infusion is continuing until subcutaneous insulin administration.
3. Monitor serum potassium level because the treatment for acidosis and dehydration can lead to hypokalemia. So, administered potassium in IVF slowly by infusion pump as per the doctor’s order. Before administration, assess the renal function of the patient and whether the patient has enough urine output or not. Cardiac monitoring is very essential for DKA clients because of abnormal serum potassium levels.
4. Monitor the vital signs of the client such as blood pressure, respiration, and pulse. So, always keep cardiac monitoring with the patient side.
5. Monitor urine output and also check for fluid overload.
6. After discharge, you need to take insulin or oral medication as per the doctor’s order. Check the blood sugar level four times per day. Inform your doctor, if you have a blood glucose level of more than 250 to 300mg/dl or if you are sick. Moreover, if you cannot eat the food properly, take a small amount of food 6 to 8 times per day. In addition, a diabetic diet plays an indispensable role to control blood glucose levels. High-fiber vegetables and fruits slow carbohydrate absorption. And exercise also helps to reduce glucose levels. Do exercise such as swimming, jogging, running, and cycling for at least 30 minutes per day. Check blood glucose levels before and after exercise because glucose is converted into energy which leads to hypoglycemia. Before discharge, teach the client about the signs and symptoms of hypoglycemia and hyperglycemia. The main hypoglycemic symptoms are excessive sweating, irritability, nervousness, shivering or tremor, hunger, nausea, headache, pallor, and palpitation. The hyperglycemic symptoms are excessive urine output, increased thirst, increased hunger, weight loss, blurred vision, fatigue or tiredness, and poor wound healing.
DKA DISEASE V/S HYPER OSMOLAR HYPERGLYCEMIC SYNDROME(HHS)
DKA disease or diabetic ketoacidosis is a hyperglycemic condition with the presence of ketosis and acidosis.
Hyperosmolar hyperglycemic syndrome is a condition that extreme hyperglycemia occurs without acidosis and ketosis and it is more common in type 2 diabetes mellitus people. Gestational diabetes mellitus is common in pregnancy. Treatment is similar to DKA disease such as fluid replacement, insulin administration, and maintaining serum potassium level.