Diabetic Ketoacidosis Mr. L is a 58 year old man who is recovering…

Diabetic Ketoacidosis
Mr. L is a 58 year old man who is recovering in the orthopedic unit of the hospital from a right
total knee replacement of two days ago. Mr. L has type 1 diabetes and was diagnosed with the
condition at 12 years of age. He has been managing his illness with blood glucose checks 4
times a day before meals and once at bedtime. He currently takes Humulin-R on a sliding scale
based on his glucose results. He weighs 315 pounds and has developed osteoarthritis in both
knees, requiring surgical replacement of the knee joint on the right side.

The nurse caring for Mr. L enters his room at 8:15 am for a morning assessment. She finds Mr.
L lying in his bed awake, but his mental status is altered and there is a fruity odor to his breath.
His vital signs are HR 100 bpm, RR 32/minute, BP 116/78 mmHg. The nurse notes that his last
blood glucose level was 156 mg/dL the previous night before bed and he received 2 units of
insulin at that time, but he has not received his morning glucose check or any insulin yet today.
A rapid bedside glucose check reveals a blood glucose level of 468 mg/dL. The nurse contacts
the physician and upon further examination, Mr. L is diagnosed with diabetic ketoacidosis.

1. Describe how diabetic ketoacidosis could develop in a patient who has undergone surgery.
2. Mr. L has an elevated respiratory rate that is classified as Kussmaul breathing. Explain this
type of respiratory pattern.

Mr. L complains of feeling very thirsty and that he can’t see very well because his vision is
suddenly blurry. The nurse notes that he has a large amount of clear urine in his catheter bag.
She takes a sample of urine and it tests positive for ketone bodies.

3. How does the body release ketones into the urine when DKA occurs?
4. Explain why Mr. L would have increased urinary output, blurred vision and increased thirst.

The physician has given orders to administer 0.9% Sodium Chloride IV at 500 mL/ hour for 1
hour, then 200mL/hour for the next 4 hours. The nurse is to start a drip of Regular insulin at 0.1
mg/kg/hour. The physician has also added orders for laboratory work, including a metabolic
profile and arterial blood gases. The metabolic panel results are:

Na 135 mEq/L
K 3.2 mEq/L
Cl 95 mEq/L
Ca 8.5 mg/dL
The arterial blood gas results are as follows: pH 7.31
pCO2 20 mmHg
pO2 95 mmHg
HCO3 12 mmol/L

5. What is the rationale for the IV fluids to be given at this rate?

6. Explain why DKA would most likely produce these types of blood gas results.

Explanation & Answer

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