Page 357 - Critical Care Nursing Demystified

342 CRITICAL CARE NURSING DeMYSTIFIED

Impaired Glucose Tolerance
This condition involves no signs or symptoms of diabetes except high glucose
levels. These patients are referred to as borderline diabetic because their blood
sugar levels are not high enough to classify or treat them as diabetics.

Complications of Diabetes Mellitus
Serious illnesses requiring critical care can develop. Neuropathy, retinopathy,
nephropathy, peripheral and cardiovascular diseases, hypertension, and hyper-
lipidemia are some examples.
DKA (Diabetic Ketoacidosis) Diabetic ketoacidosis is an acute complication of
diabetes mellitus.

What Went Wrong? DKA is a severe disorder state of fat, carbohydrate, and protein
metabolism caused by extreme insulin deficiency that manifests as severe hyper-
glycemia, metabolic acidosis, and fluid and electrolyte imbalances. It is a
life-threatening event, especially to the patient with Type 1 insulin-dependent
diabetes mellitus.
With hyperglycemia, excessive glucose rapidly escapes into the urine (glyco-
suria) because the filtering capacity of the kidneys is decreased and glucose Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
cannot be reabsorbed into the bloodstream. Excessive glycosuria and hypergly-
cemia leads to electrolyte and volume depletion, as the patient with unregulated
diabetes mellitus cannot ingest enough sodium bicarbonate and water to com-
pensate for fluid and electrolyte losses.
1. As DKA progresses, ketoacidosis occurs due to the accumulation of highly
acidic substances in the bloodstream (ketonemia) and the urine (ketonu-
ria) faster than they can be metabolized.
2. Ketoacids are excreted in the urine as Na, K , and ammonium salts.
+
3. Respirations are affected as the body attempts to compensate for a carbonic
acid buildup. Breathing becomes deep and rapid (Kussmaul’s respirations)
in an effort to release the carbonic acid in the form of carbon dioxide.
Acetone is exhaled, giving the breath a sweet, fruity odor. It is the body’s
attempt to maintain a normal pH during the throes of metabolic acidosis.

3 Hallmark Signs and Symptoms In addition to the initial symptoms of diabetes
mellitus, which are unexplained weight loss and the 3 Ps of polyphagia (exces-
sive hunger), polydipsia (excessive thirst), and polyuria (excessive urination),
the patient with DKA will also experience nausea, vomiting, extreme fatigue,
headache, and dehydration. The patient can become stuporous and uncon-
scious, slipping quickly into a coma. The nurse, on inspection, will also observe