03.04 DKA vs HHNK for CCRN Review

Nursing Points

General

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