DKA CASE STUDY
Sam, a 39-year-old, 63 kg (140 lb) African-American man, was admitted to the hospital
with diabetic ketoacidosis (DKA). After admission to the emergency room, he had multiple
episodes of emesis. Sam said he had been vomiting for the past 2 days and admitted to
skipping several doses of insulin recently. He mentioned that he had feverish feelings at home
and reported an occasional cough.
Sam’s assessment revealed the following: pain throughout all abdominal quadrants with
“cramping” reported in all four abdominal quadrants. He was extremely lethargic and difficult to
arouse at times. He complained of severe thirst. His skin was extremely dry.
Electrocardiogram (ECG) showed a sinus tachycardia at 120 bpm. Lungs were clear bilaterally,
but respirations were deep and rapid. There was an acetone smell to Sam’s breath. He denied
alcohol and illicit drug use and could recall no drug or food allergies. He did report that his
father and two aunts have insulin-dependent diabetes.
Sam’s psychosocial history revealed the following pertinent information. He works parttime as a janitor and intends to start a second job but only for 2 ½ hours a week. He stated, “I’m
on a fixed income, and my medicine runs out sometimes.” During the past year, Sam has been
admitted to the hospital with the diagnosis of DKA on March 2 nd, June 29th, and November 8th.
In addition, he had failed to keep his follow up appointments on July 18 th and November 23rd.
Sam’s diagnostic data are:
BP
HR
Respirations
Temperature
12480
122 bpm
32 / min
35.8 degrees C (96.3 degrees F) (Oral)
Hematologic Studies
Hgb
Hct
Cholesterol
Ca++
Phosphorus
Na+
K+
LDH
Alkaline phosphatase
ClCreatinine
BUN
Glucose
Acetone
AST (SGOT)
CK
14.5 g/dl
58%
338 mg/dl
8.8 mmol/L
6.8 mg/dl
126 mmol/L
5.3 mmol/L
38 U/L
132 U/L
95 mmol/L
4.9 mg/dl
52 mg/dl
560 mg/dl
moderate
248 U/L
34/35 IU/L
Arterial Blood Gases
pH
7.19
Po2
100 mm Hg
HCO3
7.5 mmo/L
Pco2
20 mm Hg
Sao2
98% (room air)
Urine
Specific gravity
1.015
Ketones
4+
Leukocytes few
Glucose
4+
Nitrates
0
RBCs
many
Home Medications
AM 16 U 70/30 insulin
PM 12 U 7030 insulin
1. What is insulin’s function in the body? What is the most significant basic defect in the
development of DKA ? Describe the interplay of factors necessary for the development
of DKA.
2. List the classic signs and symptoms of DKA.
3. Sam’s pH of 7.19 indicates severe acidosis. Discuss Sam’s arterial blood gases (ABGs)
in regard to acid-base balance.
4. Discuss the possibility of an infection in Sam’s case and the effect sepsis or infection
would have on a diabetic patient.
5. What are the goals of treatment for DKA?
6. Identify Sam’s abnormal laboratory values and describe the treatment modalities used
with a patient with DKA in regard to these values.
7. What are four major complications associated with DKA and its treatment?
8. Review Sam’s history and laboratory values to determine the diabetic complications to
which Brady is most predisposed.
9. What nursing considerations are important in planning Sam’s discharge?