diabetic ketoacidosis (DKA), an acute, life-threatening complication of uncontrolled diabetes mellitus. In this condition urinary loss of water, potassium, ammonium, and sodium results in hypovolemia, electrolyte imbalance, extremely high blood glucose levels, and breakdown of free fatty acids, causing acidosis, often with coma. Compare insulin shock. ▪ OBSERVATIONS: The person appears flushed; has hot, dry skin; is restless, uncomfortable, agitated, and diaphoretic; and has a fruity odor to the breath. Nausea, confusion, and coma are often noted. Persons with diabetes mellitus who produce no natural (endogenous) insulin are most often affected (type 1). Untreated, the condition invariably proceeds to coma and death. ▪ INTERVENTIONS: IV insulin and hypotonic saline solution are administered immediately. Nasogastric intubation and bladder catheterization may be indicated. Blood glucose and ketone levels are determined hourly, and electrolyte and acid-base balance are monitored frequently. Bicarbonate may be given in dosages dependent on the degree of acidosis. Potassium is usually given because of intracellular potassium depletion. Plasma or a plasma expander may be necessary to prevent or correct shock resulting from hypovolemia. ▪ PATIENT CARE CONSIDERATIONS: The cause of the episode of ketoacidosis is sought. The most common precipitating factors are undiagnosed type 1 diabetes mellitus, infection, GI upset, alcohol consumption, and failure to take insulin. Type 1 diabetes mellitus in childhood characteristically begins suddenly and progresses rapidly. Therefore, the diagnosis of type 1 diabetes is usually made when the child arrives at the hospital in diabetic ketoacidosis. Inpatient care after an episode of ketoacidosis is the same as for diabetes mellitus.
