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In DKA what is decreased and what is increased?
- Insulin deficiency (decreased)
- Increased levels of:
- growth hormone
During DKA the body breaks down ____ for energy?
Fat and protein (catabolism)-the breakdown of fats leads to the production of fatty acids. These undergo transformation to keto acids in the liver.
During DKA pH _____ and _____ are present in the urine, thus sharply increasing _______.
During DKA pH falls (6.8-7.3) and ketone bodies are present in the urine, thus sharply increasing osmotic fluid loss.
Metabolic acidosis ensues as the _______ decreases, and DKA results. In response to the metabolic acidosis, extracellular _____ are exchanged for intracellular _________.
bicarbonate concentration decreases
extracellular hydrogen ions are exchanged for intracellular K ions.
Respiratory compensation for the metabolic acidosis in the form of deep, labored respirations that are fruity (________), results in lowered _____ values (_______)
Kussmaul respirations- deep labored fruity
lowered Pco2 values (compensatory respiratory alkalosis.
To be diagnosed with DKA, glucose levels are_______
______ is released during stressful situations.
During DKA fluids become _______.
hyperosmotic (fluids leave cells and enter the vascular system)
Renal response during DKA
Kidneys increase urine output (K+, Na)
Potassium levels in DKA
Initially they are high, then the level falls.
In Kussmal respirations _______ is longer than ______.
expiration is longer than inspiration in an attempt to blow off excess CO2, fruity breath
In patients with DKA they are NPO until their blood glucose levels are _____
Fluids to give pts with DKA
- 1st hour - give 1L 0.9% NS, this keeps fluids in the vascular system
- 2.d hour - 0.45% NS (750 mL/hr), this is a hypertonic solution, osmolality is higher in the vascular system pushes fluids into cells
- ***When blood glucose levels reach 250 mg/dL, give 5% dextrose in 0.45% NS, this prevents hypoglycemia and cerebral edema
MUST BE ON A PUMP!
In DKA we want serum glucose to drecrease by ___ to____ per hour.
- 50-75 mg/dL/hr
- slowly over 6-8 hours until back to normal
- may have to increase or decrease rate
What is the most common precipitator for development of DKA?
S&S of DKA
- polyuria, polyphagia, polydipsia
- weight loss
- vomiting & abd pain
- altered mental status
How are keto acids formed?
Fatty acids undergo transfomation into keto acids in the liver.
fatty acids result from metabolism of fats
Keto acids cause pH to _____
In DKA you will see an increase in ____ and a decrease in _____
increase in hydrogen and decrease in bicarb