DKA: Summary and Nursing care plan

DKA
Diabetic Ketoacidosis (DKA): A summary

Diabetes mellitus is defined as the relative or absolute deficiency in insulin. This means that insulin is either not effective, or not produced sufficiently to maintain glucose homeostasis. Insulin is primarily responsible for the transportation of glucose intracellularly. So that glucose may be used as a source of energy.

Lack of insulin therefore results in cell starvation and weight loss, despite polyphagia. Any ingested glucose remains in the blood stream and, when levels become high, spills out into the urine, causing glucosuria. Osmotic pressure exerted by the unusually high levels of glucose causes movement of water out of cells, into the blood stream and causes additional water to be lost in the urine. Thus, clinical signs of dehydration, polyuria and compensatory polydipsia are seen.

What happens when there isn’t enough energy?

In the face of starvation, the body must turn to an alternative source of energy, therefore free fatty acids are metabolised, producing ketone bodies. This is initially beneficial, providing the body with a source of energy and may not have any adverse effects for a long time. However, in the face of disease, for example pancreatitis or urinary tract infection. Commonly seen in patients with diabetes mellitus, the body’s energy demand increases. Free fatty acid metabolism increases, resulting in a higher rate of production of ketones. Levels eventually overwhelm the body’s compensatory mechanisms.

Ketones are acidic, thus high levels result in a high Anion Gap metabolic acidosis, which in turn results in vomiting, inappetence and lethargy. Furthermore, ketones are excreted in the urine, where they also exert more osmotic pressure, causing further water loss. Severe dehydration and hypovolemia are seen and, if left untreated, may result in death. This process is known as DKA and can be complex to nurse,

For nursing interventions please refer to this sample care plan:

Example DKA care plan

This is a suggestion of what you may need to do with these patients but each care plan must be tailored to the individual patient and created with your Veterinary Surgeon’s input and approval.

Thanks for reading, 

Fran

References and further reading:

Bondy P., Wortinger A., 2012. Gastrointestinal In: L. Merrill., 2012 ed. Small Animal Medicine for Veterinary Technicians and Nurses. Oxford:Wiley-Blackwell. p239.

Boag A., 2012. Ketoacidosis In: C. Mooney, M. Peterson eds. 2012. BSAVA Manual of Canine and Feline Endocrinology fourth edition. Gloucester: British Small Animal Veterinary Association. p251-258.

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