Ketoacidosis (DKA)

Definition

Diabetic Ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (occasionally type 2) characterized by hyperglycemia, ketosis, metabolic acidosis, and dehydration, without insulin, the body breaks down fat for energy, producing ketones.

Triad of DKA

• Hyperglycemia: BG typically 300 to 500 mg/dL
• Metabolic acidosis: pH less than 7.35, HCO3 less than 18
• Ketosis: positive serum/urine ketones

Signs and Symptoms

Polyuria, polydipsia, dehydration, Kussmaul respirations (deep rapid breathing to blow off CO2), fruity breath (acetone), nausea, vomiting, abdominal pain, altered LOC.

Treatment

1. IV fluids: 0.9% NS initially, then 0.45% NS
2. Insulin: continuous regular insulin IV drip
3. Potassium: replace as levels fall (insulin drives K+ into cells)
4. Monitor glucose hourly; add dextrose when BG approaches 200
5. Identify and treat precipitant (infection, missed insulin)

NCLEX Relevance

Kussmaul respirations, fruity breath. Classic DKA cues. Monitor potassium closely.