The pathophysiologic changes that occurs in a patient with diabetic ketoacidosis involve a shift in the intracellular and extracellular levels. It usually happens in patient with Type I diabetes. At the beginning there is an insufficient supply of insulin circulating which will lead to a higher glucose levels that cause osmotic diuresis. As a result, glucose is permeable to the glomerular filtration (glycosuria) and is excreted in the urine. Furthermore, sodium, potassium, magnesium, calcium and phosphorus are lost because of the osmotic diuresis and glycosuria. As a consequence, the serum osmolality becomes concentrated and the patient hydration is deteriorating. The patient’s level of consciousness is altered because of the dehydration and the increase in the serum osmolality. To compensate for the lack of glucose, the body starts to breakdown amino acids as source of energy. This breakdown further increases the glucose levels in the blood and urine. Ketone which is a by-product of fat metabolism causes a shift in the pH balance and metabolic acidosis will occur as a result. The body will then try to blow off carbon dioxide to compensate excess of carbonic acid (ketone and hydrogen ions
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Electrolyte imbalances are corrected by adding 20 to 30 mEq of sodium to each liter of fluid administered. It is crucial to maintain serum potassium levels with 4 to 5 mEq/L range during the therapy. However, if the serum potassium levels are below 3.3 mEq/L, the insulin therapy should be put on a hold. In the event the patient exhibits respiratory and cardiac problems related to phosphate levels imbalance, potassium phosphate can be administrated to correct the imbalance (20 to 30 mEq/L). The nurse must be cautious especially if the patient has a history of renal failure. To avoid complications, the patient should be monitored using an electrocardiogram and the nurse must assess the patient respiratory status during the electrolyte correction (Sole, Klein & Moseley,
Electrolyte imbalances are corrected by adding 20 to 30 mEq of sodium to each liter of fluid administered. It is crucial to maintain serum potassium levels with 4 to 5 mEq/L range during the therapy. However, if the serum potassium levels are below 3.3 mEq/L, the insulin therapy should be put on a hold. In the event the patient exhibits respiratory and cardiac problems related to phosphate levels imbalance, potassium phosphate can be administrated to correct the imbalance (20 to 30 mEq/L). The nurse must be cautious especially if the patient has a history of renal failure. To avoid complications, the patient should be monitored using an electrocardiogram and the nurse must assess the patient respiratory status during the electrolyte correction (Sole, Klein & Moseley,