Diabetic Ketoacedosis

Diabetic Ketoacedosis is caused due to a deficiency of insulin in the body. This article discusses the causes, symptoms, and treatment options for Diabetic Ketoacedosis.

Running head: DIABETIC KETOACEDOSIS
Diabetic Ketoacedosis
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1DIABETIC KETOACEDOSIS
Diabetic Ketoacidosisis caused due to a deficiency of insulin in the body. As a result
of the insulin deficiency, the amino acids and triglycerides in the body are metabolized to
release energy by the process of lipolysis (Hoffman et al., 2017). This results in a rise in the
levels of free fatty acids, glycerol and Alanine in the serum. Also excess glucagon caused due
to the deficiency of insulin causes the alanine and glycerol act as substrates for hepatic
gluconeogenesis and glugagon leads to the conversion of free fatty acids into ketones in the
mitochondria (Soto-Rivera et al., 2017). The rise in ketones further causes production of beta-
hydroxybutyric acid and acetoacetic acid that causes metabolic acidosis (Sulimani et al.
2018). The pH of blood decreases due to this, making it acidic (Adachi et al., 2017).
DKA can significantly deteriorate the health condition of the patient and can be fatal
is not treated timely (Møller, 2017). According to Gilbert and Byard (2018), the acidification
of the blood (or metabolic acidosis) can lead to the production of excess hydrogen ions and
insufficient production of bicarbonate ion. This can cause several serious consequences such
as respiratory acidosis, coma and even death.
One of the most effective treatment strategies for DKA is the use of a combination of
dapagliflozin and insulin. Dapagliflozin is a selective inhibitor which is orally active which
can inhibit renal SGLT2 (renal sodium-glucose co-transporter type 2) and therefore used for
the treatment of type 2 diabetes (or diabetes mellitus) (Storgaard et al., 2016).
Ethical and legal principles of person centered care in a critical care environment
include the following aspects: The Code of Ethics, Rights based patient constitutions,
Confidentiality policies, Quality of care policies (Health.gov.au, 2019; Oecd.org, 2019;
Nursingmidwiferyboard.gov.au, 2019).
In situations where the patient’s condition is rapidly deteriorating, the healthcare
professionals in charge of the patient’s care have the role of initiating a rapid response

2DIABETIC KETOACEDOSIS
system for the patient in order to quickly identify the condition and respond to it accordingly
(Safetyandquality.gov.au, 2019). The rapid response system involves the following steps:
Event recognition and triggering response; Crisis Response; Process Improvement; and
Administration:
The response arm of the rapid response system includes the medical emergency team, rapid
response team, critical care outreach, ICU liaison nurses as well as alternate systems of care
delivery (Safetyandquality.gov.au, 2019).
Figure: Rapid response system in an acute care setting. Source (Safetyandquality.gov.au,
2019)

3DIABETIC KETOACEDOSIS
According to Australian healthcare policies, the following conditions can quality as a
medical emergency: Airway obstruction; Circulatory problems; Neurological problems:
(Safetyandquality.gov.au, 2019)
The national medicines policy (NMP) of Australia outlines the following responsibilities of
the healthcare providers while administering medications to the patients:
 Appropriateness:
 Judiciousness:
 Safety:
 Effectiveness:
(Health.gov.au, 2019; Oecd.org, 2019)
Complementary therapies for DKA include:
Physical Intervention: Yoga, Message Therapy, Acupuncture, Medicinal Herbs
Dietary supplements: Chromium, Vanadium, Magnesium, Nicotinamide, Vitamin E
Miscellaneous approach: Aromatherapy, Biofeedback, Hydrotherapy, Chromotherapy
(Lien et al., 2016; Al-Ghamdi et al., 2017; Cervera-Hernandez & Reddy, 2017)
References:

4DIABETIC KETOACEDOSIS
Adachi, J., Inaba, Y., & Maki, C. (2017). Euglycemic diabetic ketoacidosis with persistent
diuresis treated with canagliflozin. Internal Medicine, 56(2), 187-190.
Al-Ghamdi, A. H., Fureeh, A. A., Alghamdi, J. A., Alkuraimi, W. A., Alomar, F. F.,
Alzahrani, F. A., ... & Alghamdi, A. M. (2017). High prevalence of vitamin D
deficiency among Saudi children and adolescents with type 1 diabetes in Albaha
Region, Saudi Arabia. IOSR J. Pharm. Biol. Sci, 12, 5-10.
Burke, K. R., Schumacher, C. A., & Harpe, S. E. (2017). SGLT 2 Inhibitors: A Systematic
Review of Diabetic Ketoacidosis and Related Risk Factors in the Primary Literature.
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 37(2),
187-194.
Cervera-Hernandez, M. E., & Reddy, N. (2017). Garcinia Cambogia, diabetic ketoacidosis,
and pancreatitis. Rhode Island Medical Journal, 100(10), 48.
Gilbert, J. D., & Byard, R. W. (2018). Fatal diabetic ketoacidosis—a potential complication
of MDMA (ecstasy) use. Journal of forensic sciences, 63(3), 939-941.
Health.gov.au. (2019). Department of Health | Policy. Retrieved from
http://www.health.gov.au/internet/main/publishing.nsf/Content/Policy-1
Health.gov.au. (2019). Department of Health | Quality Use of Medicines (QUM). Retrieved
from http://www.health.gov.au/internet/main/publishing.nsf/Content/nmp-quality.htm
Hoffman, W. H., Artlett, C. M., Boodhoo, D., Gilliland, M. G., Ortiz, L., Mulder, D., ... &
Rus, H. (2017). Markers of immune-mediated inflammation in the brains of young
adults and adolescents with type 1 diabetes and fatal diabetic ketoacidosis. Is there a
difference?. Experimental and molecular pathology, 102(3), 505-514.

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Jehle, D., Johnson, D., Martel, T., Molnar, J., Lark, M. C., Falkowitz, J., ... & Nambudiri, V.
(2017). Severe diabetic ketoacidosis presenting with negative serum ketones. The
American journal of emergency medicine, 35(1), 196-e3.
Lien, A. S. Y., Jiang, Y. D., Mou, C. H., Sun, M. F., Gau, B. S., & Yen, H. R. (2016).
Integrative traditional Chinese medicine therapy reduces the risk of diabetic
ketoacidosis in patients with type 1 diabetes mellitus. Journal of ethnopharmacology,
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Møller, N. (2017). Acute Metabolic Complications of Diabetes: Diabetic Ketoacidosis and
the Hyperosmolar Hyperglycemic State. Textbook of Diabetes, 534-539.
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https://www.nursingmidwiferyboard.gov.au/news/2017-09-28-new-codes-of-
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