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DIABETIC KETOACIDOSIS PATHOPHYSIOLOGY Diabetic Ketoacidosis DKA is serious condition characterized by high blood glucose dehydration nausea and vomiting and the presence of ketones Ketones are made when your body burns fat instead of glucose for energy This occurs when there is not enough insulin It usually occurs in patients with Type 1 diabetes but can develop in patients with Type 2 diabetes as well DKA may be the initial manifestation of previously unrecognized Type 1 diabetes Most commonly it develops in patients who fail to take their insulin or who do not receive extra insulin during stress infection heart attack surgery A common misconception by physicians and patients is that if a patient with Type 1 diabetes is not going to eat that he or she should not take any insulin The mortality associated with DKA is less than 5 Ketoacidosis is common caused by not taking insulin infection new onset of type 1 diabetes and leaving insulin at 80 degrees or higher or letting the insulin freeze SIGNS AND SYMPTOMS Dry mouth Great thirst Fruity breath Loss of appetite Stomach pain Nausea Fever can be absent Fatigue Drowsiness Frequent urination Labored breathing Vomiting Medical Treatment The goal of treatment is to correct the elevated blood-glucose level by the administration of additional insulin and replace fluids lost through excessive urination and vomiting Often a person with diabetes will be able to recognize the early warning signs and make appropriate corrections at home before the condition progresses to coma If ketoacidosis is severe hospitalization is required to control the condition Insulin replacement will be given fluid and electrolytes will be replaced and the cause of the condition such as infection will be identified and treated NURSING DIAGNOSIS Altered nutrition Altered urinary elimination Fluid volume deficit NURSING INTERVENTIONS Keep accurate records of vital signs weight fluid intake urine output and calorie intake Monitor of acute compication of diabetic therapy especially hypoglycemia Observe
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