DKA Case Study
Name:_Lindsey Gamrat
John is an 18-year-old male with type I Diabetes. He is in the middle of his first semester of college. He
has been brought to the ED by his roommate, who says that John began not feeling well while in their
dorm room. John’s blood sugar is 1234, and the ED physician diagnoses him with DKA. John is admitted
to the ICU.
1. Please describe three PHYSICAL and two LABORATORY findings you would expect to see in this
patient. Provide rationale.
This patient will likely be experiencing polyuria due to the increased blood glucose levels causing a
hyperosmolar state in the body. Losing all of this fluid will lead to fluid volume deficit that will cause the
patient to feel extremely thirsty (polydipsia). He may also have a fruity or metallic smelling breath. This
is caused by the buildup of ketones in the body to a point where you can actually smell it on the
patient’s breath. A laboratory finding in addition to elevated blood glucose could be elevated serum
potassium. Insulin acts to move potassium out of the vasculature and in to the cells. A lack of insulin
causes potassium to accumulate in the blood leading to hyperkalemia. An ABG would also reveal
acidosis (pH less than 7.35). Ketone bodies are acidic and therefore an accumulation of them lowers the
blood’s pH.
2. Identify three nursing diagnoses associated with John’s diagnosis of DKA. Provide rationale.
One nursing diagnosis associated with DKA is fluid volume deficit. The hyperosmolar state of the
body causes excessive diuresis. Patients in DKA can become very dehydrated. Fluid volume
deficit can then lead in to another nursing diagnosis: decreased cardiac output. Low blood
volume and potential arrhythmias caused by potassium shifts could cause the heart not to pump
as effectively. Another nursing diagnosis that would follow decreased cardiac output is altered
tissue perfusion. If the heart is not effectively pumping blood, tissues and organs are not getting
enough of the oxygen rich blood they need to function.
3. Identify two nursing and two medical interventions that would be appropriate for John. Provide
rationale.
One of the most important nursing interventions for a patient in DKA is education. The patient
needs to understand why the DKA occurred and what they can do to prevent it in the future. If
they have been newly diagnosed with diabetes, they will likely need a lot of education not just
on preventing DKA, but managing life with diabetes. The nurse also needs to encourage
adequate food and fluid intake. As the hyperglycemia is treated, hypoglycemia actually becomes
a concern. Adequate intake can help prevent this. The patient will also be extremely dehydrated
so fluid intake is important. One of the main medical interventions will be to decrease blood
glucose levels. This is usually done with IV insulin and most be done very slowly to avoid
hypoglycemia and rapid shifts in potassium. In fact, when blood glucose is approaching desirable
levels, IV dextrose is usually given with IV insulin to try and avoid hypoglycemia. Blood glucose
levels will be very frequently monitored. The patient’s dehydration will also need to be treated
so IV fluids in addition to the IV insulin will be given. Again it is important to monitor potassium
and blood glucose closely. Additionally, the underlying cause of the DKA will need to be treated
whether it be infection, illness, undiagnosed Type I diabetes or inadequate management of
already diagnosed diabetes.