Cause of Ms. S’s Diabetic Ketosis Acidosis (DKA)
Ms. S’s Diabetic Ketosis Acidosis (DKA state is one of the most extremes of diabetic decompensation since it is associated with high mortality rate. The incidence of Ms. S’s DKA, usually, occurs at 4.6-8.0 per 1000 persons-year among the patients with diabetes. The pathogenesis of the condition occurs as a result of the abnormalities associated from the combination of relative or absolute insulin deficiency (Health & Medicine Week, 2014). When the level of insulin is deficient, the increased levels of glucagon cortisol and catecholamins will automatically stimulate hepatic glucose production through enhanced gloconeogenesis and increased glycogenolysis. The combined level of increased levels of cortisol, catecholamins and growth hormone will activate hormone-sensitive lipase. The active hormone lipase will cause the breakdown of triglycerides to release free fatty acids. This progression results in increased concentration levels of [beta]-Hydroxybutyric acid, acetone and acetoacetic acid retained in the kidneys. The increased level of these impurities, usually, leads to malfunctioning of the glomerular filtrate thus resulting to the Diabetic Ketosis Acidosis (DKA) state (Mahler et al, 2011).
Diagnosis
Clinical Presentation
The clinical presentation of the Ms. S’s DKA can provide great information for the required diagnosis. The main per-se clinical conditions of the disease are abdominal pain with nausea, rapid and deep respiration (Kussmaul-kien respiration), dehydration and vomiting (Health & Medicine Week, 2014). A definitive laboratory diagnosis is, usually, necessary to confirm the condition. A typical laboratory finding indicates that most patients exhibiting the condition have plasma glucose level of 14mmol/L or higher. Patients with the DKA condition will also exhibit an anion gap (Na+ - Cl- + HCO3-), increased blood urea nitrogen (BUN), hyponatremia, and the serum amylase. The total body phosphate level may be relatively low, but the serum level may be recorded as normal or elevated. The laboratory anion gap may be > 10-12 meq/L and serum bicarbonate (HCO3) ≤ 18 mEq/L. The increased level of serum osmology is also dominant in DKA patients. Most patients bearing this condition always have low levels of leucocytes. Apart from laboratory test, blood culture, urine culture, urinalysis, chest radiography and electrocardiography should be effectively carried out (Mahler et al, 2011).
Sick Day Rules for Patients with Diabetic Ketosis Acidosis (DKA) Condition
The success of care and treatment of Ms. S’s DKE mainly depends on the correction of dehydration deficiency. The main aim of fluid therapy on Ms. S’s is to increase the intracellular volume and restore the renal perfusion. Meticulous follow up of Ms. S’s vital signs, clinical conditions and laboratory parameter are important before her discharge (Health & Medicine Week, 2014). These vital signs of the condition should be monitored after every one hour and within the 2-4 hours until resolution of the condition emerges. An hourly record to monitor the level of urine output from the kidney is necessary. The nurse should further focus on the Ms. S’s neurological status. On the neurological status, the nurse should monitor of acid-base status, serum glucose, and serum electrolytes. The choice of fluids replacement will mainly depend on the state of dehydration, urinary output and electrolyte levels. In most circumstances, the nurse may infuse 0.4% of sodium chloride per 4-14mL/kg hour for the dehydration level to be corrected (Health & Medicine Week, 2014).
Important Health Considerations in Planning Ms. S’s Discharge
Before Ms. S’s discharge, a comprehensive profile of the best strategies used to correct the patient’s condition should be ascertained. The patient should be advised on how to make the required hourly insulin adjustment while at home (Mahler et al, 2011). Further, Ms. S’s may make appropriate referrals and psychological treatments after the discharge. A specialist in the areas will set up appropriate management plan which will include referral visits, nutritional balance and advice on the best management practices.
References
Diabetes; study data from Christ church hospital update knowledge of diabetes (medically facilitated discharge of adult diabetic ketoacidosis admissions: Precipitants and average length of stay). (2014). Health & Medicine Week, , 140. Retrieved from http://search.proquest.com/docview/1545279693?accountid=1611
Mahler, S. A., Conrad, S. A., Wang, H., & Arnold, T. C. (2011). Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis. The American Journal of Emergency Medicine, 29(6), 670-4. doi:http://dx.doi.org/10.1016/j.ajem.2010.02.004
