Paper Example on Diabetic Ketoacidosis

Background Evidence - Historical Contexts

Diabetic ketoacidosis or DKA is one of the most life-threatening metabolic disorders observed in both humans and the veterinary medicine. As a severe complication of diabetes mellitus, DKA is characterized by the deficiency of Insulin and the increased hormones such as the glucagon, cortisol, catecholamine, as well as the growth hormones. Biochemically, the DKA is demonstrated as an increase in the serum concentration of ketones greater than the 5mEq/L, the blood glucose level higher than 250mg/dL, and the blood PH of less than 7.3. It is important to recognize that DKA signs often manifest rapidly, sometimes within the first 24 hours of infection (Rewers et al. 2008).

Fundamentally, the increased hormones secretion and the insulin deficiency often lead to dehydration, electrolyte imbalance, the hyperglycemia, and ketosis. Such conditions are also associated with the presence of the substances called the ketones in urine and decreased the concentration of the bicarbonate in the blood. In most of the occasions, DKA will often lead to death, but proper diagnosis and treatment are crucial in saving the life. Many studies have shown that DKA develops in the previously unrecognized or treated diabetes. In this sense, the identification of diabetes mellitus or the development of the additional symptoms in the patient or animal known to be diabetic to prevent the disorder from occurring is substantially crucial (Guthrie, Guthrie, & Guthrie, 2002).

The study by Herrington et al. provided valuable findings regarding prevalence and management of DKA. They collected simultaneous arterial and venous samples from 206 seriously ill individuals and later subjected them to analysis in duplicates. The calculation of the variations coefficients and the 95 percent limit of agreement for both the samples demonstrated similarity regarding pH, serum bicarbonate, and potassium (Herrington et al. 2012). This finding indicated that both are adequately reliable for the management of critically ill patients suffering from DKA.

Statement of the Problem

As a life-threatening metabolic disorder, DKA leads to death when a patient goes without proper and consistent medical attention. Various researchers have shown that DKA develops in the previously unrecognized or treated diabetes. In this sense, the identification of diabetes mellitus or the development of the additional symptoms in the patient or animal known to be diabetic to prevent the disorder from occurring is substantially crucial. Administration of the oral insulin or insulin therapy as directed by the doctor forms an integral part of treatment and management, and should, therefore, be encouraged.

Impact on the Community

DKA is defined clinically as an acute state of severe unregulated diabetes associated with the ketoacidosis-producing derangements in the intermediary metabolism. The major primary causes of DKA include the underlying infection, disruption of the insulin treatment and the new development of diabetes (Rewers et al. 2008). As a result, the patient is subjected to symptoms such as the excessive thirst, regular urination, restlessness, nausea, and vomiting, as well as breathing problems (Shereen, 2013). Other symptoms include the increased serum glucose concentration and Ketones in the urine, in addition to the low serum bicarbonate level in the blood. The community may, therefore, use huge financial resources to treat individuals with these diseases. Besides, the death of patients may reduce economic development, especially when the deceased a source of development (Zargar, Wani, Masoodi et al. 2009).

Intervention Strategies and Solutions

Various intervention and strategies can be used about the DKA. These responses occur in the form of drug administration for treatment, as well as the management and prevention techniques to reduce the disease prevalence and occurrence.

Treatment through Drug Administration

DKA is treatable, especially when diagnosed at an earlier stage. Upon the diagnosis, the patient may receive specialized treatments in the diagnosis room or receive a hospital admission. Such admission and treatment usually involve various interventions such as the fluid replacement, electrolyte replacement, and the insulin therapy, about the fluid replacement, the patient is made to receive the fluids either orally or intravenously until the patient is rehydrated. In such conditions, the fluid is added to the body to reverse the loss as well helping to dilute the high level of sugar in the patients blood (Kitabchi et al. 2008).

In the same way, the electrolyte replacement is crucial in the treatment of DKA (Guthrie, Guthrie, & Guthrie, 2002). Notably, the electrolytes refer to the body minerals that transport the charges that include the potassium, chloride, and sodium. The insulin therapy further helps in the reversal of the factors that influence the development of DKA. Other than the fluids and the electrolytes, an individual suffering from DKA should also receive an insulin treatment usually intravenously. In an event where the blood sugar goes below 240mg/dL, and the blood is non-acidic, the doctor will be able to cease the administration of insulin and after that advise the patient to resume his or her conventional insulin therapy (Kitabchi et al. 2008).

Management and Prevention

As Guthrie, Guthrie, & Guthrie (2002) asserts, the administration and prevention of DKA are one of the major ways of reducing the risks and costs involved in its treatment. There are numerous ways through which individuals can take to prevent the DKA and the additional arising complications. Patients commitment to managing their diabetes is a significant step for the disorder prevention. In this way, patients should make healthy eating and physical activity greater components of their daily routine. Administration of the oral insulin or insulin therapy as directed by the doctor is also necessary. Finally, the patients need to monitor their body sugar level and regulate their drugs dosage as required and assessing the ketone level should be embraced.

Epidemiology

Despite the advancement in the self-care for the patients with diabetes, the DKA has continued to account for nearly 14 percent of the total hospital admissions of patients with diabetes. In the same way, it has contributed to 16 percent of all the diabetes-related to DKA. A study conducted by the World Health Organization showed that nearly 50 percent of the admissions of people suffering from the diabetes-related illnesses are related to the DKA. As such, the disease is mostly observed during the diagnosis of type 1 diabetes and often indicates this diagnosis. While the exact incidence is not known, various studies have estimates it to be 1 out of 2000.

The DKA conditions primarily occur in patients who have the type 1 diabetes. In most occasions, the incidences are estimated to be two episodes in every 100 patient years of diabetes, with 3 percent of them with type 1 diabetes initially offering a presentation of the DKA. The disease can also occur in the patients with type 2 diabetes but is less common. It is, however, important to recognize that the incidence of the disease in developing nations is not known but may be slightly higher than in the developed countries.

A study by the CDC revealed that the DKA incidence is greater in whites based on the high prevalence of the type 1 diabetes within this racial group. Its incidence is further slightly greater in the females than in males, though the little scientific evidence is available to support this finding exists. Finally, the recurrent DKA are observed in young women with type 1 diabetes and is mainly contributed by an omission of insulin medication. The majority of the affected group are usually young children and adolescents as compared to young adults.

References

Herrington WG, Nye HJ, Hammersley MS, Watkinson PJ. (2012): Are arterial and venous samples clinically equivalent for the estimation of pH, serum bicarbonate and potassium concentration in critically ill patients?. Diabet Med. 2012 Jan. 29(1):32-5

Guthrie, D. W., Guthrie, R. A., & Guthrie, D. W. (2002). Nursing management of diabetes mellitus: A guide to the pattern approach. New York: Springer

Kitabchi, A. E., Umpierrez, G. E., Fisher, J. N., Murphy, M. B., & Stentz, F. B. (2008). Thirty years of personal experience in hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. The Journal of Clinical Endocrinology & Metabolism, 93(5), 1541-1552.

Rewers, A., Klingensmith, G., Davis, C., Petitti, D. B., Pihoker, C., Rodriguez, B., ... & Dabelea, D. (2008). Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics, 121(5), e1258-e1266.

Shereen, A. (2013). Diabetic Ketoacidosis: Clinical Practice Guidelines. INTECH Open Access Publisher.

Zargar AH, Wani AI, Masoodi SR, et al. (2009): Causes of mortality in diabetes mellitus: data from a tertiary teaching hospital in India. Postgrad Med J. 2009 May. 85(1003):227-32