DKA and HHS

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Questions and Answers

Explain why individuals in DKA often present with Kussmaul breathing. What is the body attempting to compensate for?

Kussmaul breathing is the body's attempt to compensate for metabolic acidosis by increasing the respiratory rate and depth to expel excess carbon dioxide, thus raising the pH.

Describe the role of osmotic diuresis in both DKA and HHS. How does it contribute to the electrolyte imbalances seen in these conditions?

Osmotic diuresis, caused by high glucose levels, leads to excessive water and electrolyte loss through urine. The loss of electrolytes such as potassium, sodium, and phosphate, leads to electrolyte imbalances.

Why is there an absence of significant ketosis in HHS compared to DKA, despite both conditions involving severe hyperglycemia?

In HHS, there is typically some residual insulin production, enough to prevent the breakdown of fats for energy into ketones, even though it is not adequate to normalize blood glucose.

During the initial management of DKA according to the 'C' of the ABCDE approach, why is 0.9% saline the preferred intravenous fluid? Explain its purpose.

0.9% saline is used for initial volume resuscitation to correct the dehydration caused by osmotic diuresis and to improve circulatory volume without causing rapid changes in serum osmolarity. Signup and view all the answers

Explain why frequent monitoring for changes in mental status is important in the 'D' (Disability) component of managing both DKA and HHS.

Changes in mental status can indicate the severity of cerebral dehydration or cerebral edema, both of which are dangerous complications arising from extreme hyperglycemia or rapid osmolar shifts. Signup and view all the answers

In the 'E' (Exposure) assessment of the nursing management of DKA, why is a thorough examination for potential sources of infection critical?

Infections can be the precipitating cause of DKA by increasing insulin resistance and triggering the release of counter-regulatory hormones, which exacerbate hyperglycemia. Signup and view all the answers

Explain the consequences of peripheral vascular disease in patients with chronic Type 2 diabetes, particularly concerning wound healing.

Peripheral vascular disease impairs blood flow to the extremities, reducing oxygen and nutrient delivery, which leads to delayed wound healing, ulcers, and potentially gangrene. Signup and view all the answers

Describe the link between insulin administration and serum potassium levels and why this is a critical consideration in the treatment of DKA.

Insulin shifts potassium from the extracellular to the intracellular space, thus lowering serum potassium levels. In DKA treatment, monitoring potassium is crucial to prevent hypokalemia and arrhythmias. Signup and view all the answers

Explain how chronic hyperglycemia in Type 2 diabetes contributes to the development of nephropathy. What specific damage occurs to the kidneys?

Chronic hyperglycemia damages the small blood vessels in the kidneys (glomeruli), leading to protein leakage (proteinuria), reduced kidney function, and eventual chronic kidney disease. Signup and view all the answers

What is the primary mechanism behind the development of neuropathy in individuals with long-standing Type 2 diabetes?

The primary cause of neuropathy in diabetes is chronic exposure to high blood glucose levels, which damages the nerve fibers and impairs their ability to transmit signals effectively. Signup and view all the answers

Why might a patient with HHS present with more pronounced neurological symptoms (such as seizures or coma) compared to a patient with DKA?

HHS often leads to higher serum osmolarity levels due to more severe hyperglycemia and dehydration, causing significant shifts in fluid balance and impacting brain function, thus resulting in greater neurological symptoms. Signup and view all the answers

Describe the difference between polyuria in DKA and HHS, and relate it to the differing levels of hyperglycemia in these conditions.

In both DKA and HHS, polyuria results from osmotic diuresis due to high blood glucose. HHS has more severe hyperglycemia (over 30 mmol/L), so the polyuria is significantly more pronounced than in DKA (over 14 mmol/L). Signup and view all the answers

In the context of diabetic retinopathy, explain how damage to the eye's blood vessels can lead to vision loss.

Damage to retinal blood vessels leads to leakage, swelling, and abnormal blood vessel growth. This can result in blurred vision, floaters, and, if left untreated, permanent vision loss. Signup and view all the answers

Explain why patients with chronic Type 2 diabetes have an increased risk of infections. What physiological factors contribute to this?

High blood glucose impairs the function of immune cells, reducing their ability to fight off infections. Additionally, poor circulation can delay wound healing and increase infection risk. Signup and view all the answers

Why is it important to administer oxygen via a non-rebreather mask with a high flow rate (15L) during the initial management of DKA or HHS?

High-flow oxygen via a non-rebreather mask ensures maximum oxygen delivery to tissues, compensating for potential hypoxemia due to reduced oxygen-carrying capacity and impaired oxygen utilization in DKA or HHS. Signup and view all the answers

Outline the process by which high blood glucose levels in DKA and HHS lead to dehydration, and explain why this dehydration is considered 'osmotic'.

High blood glucose increases the osmolarity of the blood, drawing water from the body tissues into the bloodstream. The kidneys then filter the excess glucose and water, leading to increased urination and dehydration. This dehydration is 'osmotic' because it's driven by the osmotic pressure of the glucose. Signup and view all the answers

In managing DKA and HHS, why is it critical to avoid rapid correction of hyperglycemia? What potential complication can arise from reducing blood glucose too quickly?

Rapid correction of hyperglycemia can lead to cerebral edema, as abrupt shifts in serum osmolarity cause fluid to move rapidly into brain cells. This can cause swelling and neurological damage. Signup and view all the answers

Explain the significance of monitoring a patient's ECG during DKA treatment, particularly in relation to potassium levels. What ECG changes might indicate hypokalemia or hyperkalemia?

ECG monitoring is essential because potassium imbalances can cause arrhythmias. Hypokalemia may show flattened T waves or U waves, while hyperkalemia may show peaked T waves or QRS widening. Signup and view all the answers

Describe how chronic hyperglycemia contributes to peripheral neuropathy. Specifically, what changes occur at the cellular level within the nerves?

Chronic hyperglycemia leads to the accumulation of sorbitol and fructose within nerve cells, causing osmotic damage and swelling. Additionally, it impairs nerve signal transmission and reduces nerve blood flow. Signup and view all the answers

Explain how retinopathy due to diabetes affects the structure and function of the blood vessels in the retina, and how these changes contribute to vision loss.

In diabetic retinopathy, high blood sugar damages the blood vessels in the retina, causing them to weaken, leak fluid and blood, and form abnormal new vessels. These changes disrupt the retina's ability to properly process light, leading to blurred vision, distortion, and potentially blindness. Signup and view all the answers

Flashcards

DKA (Diabetic Ketoacidosis)

A life-threatening complication of Type 1 diabetes characterized by absolute insulin deficiency, leading to fat breakdown and acidic ketone production.

Ketones

Acidic byproducts of fat metabolism that accumulate due to insulin deficiency in DKA.

Kussmaul Breathing

Deep, labored breathing pattern characteristic of DKA, aimed at expelling excess carbon dioxide to reduce acidosis.

HHS (Hyperosmolar Hyperglycemic State)

A state primarily in Type 2 diabetes involving severe hyperglycemia and dehydration without significant ketone production.