Included In This Lesson
Study Tools
DKA vs HHNS
(Cheat Sheet)
DKA Pathochart
(Cheat Sheet)
HHNS Pathochart
(Cheat Sheet)
Outline
Nursing Points
General
- DKA (Diabetic Ketoacidosis) vs HHNK (Hyperglycemic Hyperosmolar Non-Ketotic Coma)
- Diabetic ketoacidosis
- Blood sugar 400-900
- Dehydrated
- No insulin
- Fat is broken down for energy -> ketones released -> acidosis -> kussmaul breathing
- When in acidosis, should have elevated K+
- Normally -> K+ increased 0.6 for every drop in PH of 0.1
- Acid moves into cell and K+ leaves cell (both + charged)
- When in acidosis, should have elevated K+
- Treatment
- Insulin – more (gtt)
- Fluids – less
- Normal saline
- When stable -> 0.45 percent saline (hydrate cells)
- When BS decreased (250-300) -> change to D5 1/2 saline (prevent hypoglycemia & decrease cellular edema)
- Hyperglycemic hyperosmolar non-ketotic coma
- Blood sugar 1000-2000
- Severely dehydrated (effects brain)
- Symptoms neurological
- Have insulin, but is busy preventing fat from breaking down -> no acidosis -> barely breathing
- Causes
- Old age
- Diet controlled diabetes
- TPN (pancreatic fatigue from too much glucose)
- Pancreatitis (pancreas ingesting itself)
- Medications
- Thiazides (kidneys hold glucose -> pancreatic fatigue)
- Steroids (body becomes resistant to insulin)
- Treatment
- Insulin – less
- Fluids – more
- Diabetic ketoacidosis
