HHS & DKA PPTx Flashcards
(26 cards)
what type of diabetes is HHS most associated with?
type 2 DM
what type of diabetes is DKA most associated with?
type 1 DM
which is easily treated and which is more severe?
DKA → easily treated
HHS → more severe
what is the patho of T1DM? (hint 3)
1) autoimmune disease where the body starts to attack the beta cells in our immune system
2) the pancreas is NOT producing ANY insulin
3) usually triggered by something → people can be carriers without actually having type 1 DM
what is the patho of T2DM? (hint 4)
1) Primary thing → insulin resistant
2) Tend to be above ideal body weight; HTN
3) Have chronic state of inflammation → too much epinephrine & aldosterone
4) When people have insulin resistance → the cells do not allow glucose to get in and they get into a hyperglycemic state
List the diagnostic criteria for DM
1) A1c of 6.5% or greater (2 separate)
2) Sx of diabetes plus a glucose level > 200 mg/dL
3) Fasting plasma glucose greater than or equal to 126 mg/dL → Fasting is defined as no caloric intake for at least 8 hours (2 separate levels)
4) Two hour postprandial glucose > 200 mg/dL during an oral glucose tolerance test → The test should be solution equivalent to 75 g of glucose
List common causes of DKA (5)
1) New onset type 1 DM
2) In those with type 1 DM → who stop taking insulin for whatever reason, insulin is not effective, outdated, not stored properly
3) Purposeful omission of insulin for fear of weight gain, gaining control of chronic illness
4) Drugs that affect carbohydrate metabolism, including glucocorticosteroids, higher-dose thiazide diuretics, sympathomimetic agents, and newer “atypical” antipsychotic agents
5) Physical/ emotional stress. Infection or inflammatory response
list less common causes of DKA (2)
1) Sodium-glucose co-transporter 2 (SGLT2) inhibitors, mostly used in type 2 diabetes but also off-label in type 1 diabetes. There is a complex physiology that has results in reports of DKA in both types of diabetes
2) Cocaine use, which has been associated with recurrent DKA
Regarding patho of DKA, what happens when there is no insulin? (3)
1) The cells can not use the glucose for energy
2) The liver will then convert glycogen to glucose
3) Causes hyperglycemia
Regarding patho of DKA, the kidneys causes an ______ ______
osmotic diuresis
In DKA, what does osmotic diuresis cause? (3)
1) The hyperosmolality of the ECF stimulates thirst, resulting in polydipsia
2) Causes a fluid shift from the intracellular to the extracellular space
3) This fluid shifting causes low or normal serum sodium levels despite water losses with polyuria; Called pseudohyponatremia
In DKA, the lack of insulin causes breakdown of what? Which in turn causes what?
The lack of insulin causes breakdown of fat (lipolysis) into free fatty acids and glycerol
The free fatty acids are converted into ketone bodies by the liver
In DKA, the excessive production of ketone bodies leads to the development of metabolic acidosis
What is the compensation mechanism in DKA?
Respiratory center stimulated to blow off its respiratory acid, leading to rapid deep respirations known as kussmaul respirations
What are the diagnostic criteria for DKA? (6)
1) Blood glucose levels greater than 250 mg/dL
2) Low serum pH (6.8 to 7.3)
3) Low serum bicarbonate (0 to 15 mEq/L)
4) Accumulation of serum and urine ketones (high)
5) Presence of glucose in the urine
6) Abnormal levels of serum electrolytes (sodium, potassium, and chloride)
list the manifestations of DKA (5)
1) Polyuria
2) Polydipsia
3) Weakness
4) Malaise
5) Blurry vision
why do DKA pts experience blurry vision?
due to edema on the lens related to hyperglycemia
This comes from the edema in the macula
list the manifestations of volume depletion r/t DKA (12)
1) Orthostatic hypotension
2) Warm, dry skin
3) Decreased skin turgor
4) Dry mucous membranes
5) Volume depletion causes severe drop BP
6) Anorexia
7) Nausea
8) Vomiting
9) Abdominal pain
10) The acetone breath (fruity odor)
11) Kussmaul respirations (compensation)
12) Mental status changes (Na+)
What is the priority tx in DKA and why?
Fluid resuscitation → because it deals with ABC’s; b/c the BP will be compromised
What is the order tx is done in DKA?
first rehydration
second insulin
third potassium unless level is <3.3
Rehydration in DKA is important for maintaining what?
tissue perfusion
Fluid replacement in DKA increases the excretion of what?
of excessive glucose by the kidneys
During rehydration in DKA, how much fluid may the pt need and why?
May need as much as 6-9 L of IV fluid to replace fluid losses caused by polyuria, hyperventilation, diarrhea, & vomiting
What protocol is done regarding fluid replacement in DKA?
Two bag protocol
1) start with 0.9%
2) as blood sugars begin to reduce more than 50/50 with 0.9% and 0.45%
3) blood sugar less than 300– all 0.45%
ex: 1 to 2 L x first 1 to 2 hours and then 1 L/hr for 3-4 hrs, depending on response
Once volume restore change the fluid to 0.45% NSS
what is the nurses responsibility during rehydration?
Treat the patient… assess for signs of fluid balance
Watch for cerebral edema
