Diabetic ketoacidosis (DKA) is a life-threatening problem where the body has too little insulin, so it breaks down fat and makes acids called ketones. Blood sugar is high, the blood becomes acidic, and the client loses a lot of fluid. Your priorities are fluids first, then insulin, and close potassium monitoring.
Each care plan below follows the nursing process (ADPIE).
Deficient Fluid Volume
- Osmotic diuresis from high blood glucose
- Vomiting
- Blood glucose over 250 mg/dL
- Polyuria and thirst
- Dry mucous membranes and poor skin turgor
- Tachycardia and hypotension
- Heart rate and BP return toward baseline within 4 to 6 hours
- Urine output of at least 30 mL/hr
- Client stays well hydrated and knows how to manage sick days at home
- Vital signs and urine output hourly
- Blood glucose hourly
- Mental status
- Skin turgor and mucous membranes
| INTERVENTION | RATIONALE |
|---|---|
| Give IV fluids as ordered, usually 0.9% normal saline first | Fluid replaces volume losses and helps lower blood glucose. |
| Add dextrose to IV fluids when blood glucose falls to the ordered level, often about 200 to 250 mg/dL | This prevents low blood sugar while insulin keeps clearing ketones. |
| Monitor for signs of fluid overload | Fast fluids can overload clients with heart or kidney problems. |
| Teach sick-day rules before discharge | Checking glucose and ketones and never skipping insulin prevents future DKA. |
EVALUATION
- Vital signs are back to baseline
- Urine output meets the goal
- Client explains sick-day rules
Risk for Electrolyte Imbalance
- Insulin moving potassium into the cells
- Fluid losses from diuresis and vomiting
- Acidosis
- Potassium stays between 3.5 and 5.0 mEq/L during treatment
- Client is free of dysrhythmias and electrolyte problems at discharge
- Potassium at least every 1 to 2 hours or as ordered
- Cardiac monitor for rhythm changes
- Anion gap and blood gases
- Muscle weakness
| INTERVENTION | RATIONALE |
|---|---|
| Confirm potassium is at least 3.3 mEq/L before starting an insulin drip, or as ordered | Insulin drives potassium into cells and can drop it to dangerous levels. |
| Give regular insulin by IV infusion as ordered | IV regular insulin lowers glucose and stops ketone production. |
| Replace potassium as ordered once urine output is confirmed | The kidneys must be working to safely give potassium. |
| Keep the client on a cardiac monitor | Both high and low potassium can cause deadly dysrhythmias. |
EVALUATION
- Potassium stays in range
- Rhythm stays normal
- Anion gap closes
Quick answers
What must the nurse check before starting an insulin drip in DKA?
The potassium level. Insulin pushes potassium into the cells, so a low starting level can drop to a dangerous point.
What type of breathing is seen in DKA?
Kussmaul respirations, which are deep and rapid. The body is trying to blow off acid as carbon dioxide.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.