Pathophysiology of Diabetic Ketoacidosis: Enhancing Knowledge and Evidence-Based Nursing Practice

This article discusses the pathophysiology of diabetic ketoacidosis and the importance of enhancing knowledge and incorporating evidence-based nursing practice for improved patient health. It also highlights the role of registered nurses in assessing and intervening in the clinical condition.

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ABSTRACT
The following discusses about the pathophysiology of diabetic ketoacidosis which is a serious
disease leading to ketone bodies buildup in the blood system. It is incumbent upon the
registered nurses to enhance their knowledge and learning skills and incorporate the evidence-
based nursing practice to improve the patient health and management of the disease. It is
INTRODUCTION
Diabetic ketoacidosis (DKA)results from increase in the levels of ketone bodies in the blood system
due to deficiency of insulin which causes insulin to move from blood into the liver. The rise of glucose
levels in blood system is the cause for the lipolysis or break down of free fatty acids in liver, thereby
releasing energy with the formation of keto acids like beta-hydroxy butyric acid and acetoacetic acid
(Soto-Rivera et al., 2017). This in turn leads to metabolic acidosis which causes reduction in blood
pH.The patient condition becomes serious due in response to metabolic ketoacidosis which is the major
focus area for the health care professionals, particularly registered nurses to assess and intervene the
clinical condition and bring about improvement in patient’s health through their enhancement of
knowledge and incorporating evidence-based nursing practice in critical care improvement.
DISCUSSION
The efficient treatment of DKA begins with complete knowledge of the pathophysiology of the
disease. The registered nurses have a crucial role to play in this scenario. The registered nurses need to
have a wide knowledge of the combination of drugs that can yield positive outcomes for patients. In
case of a deteriorating patient, the concern becomes critical; the registered nurses should intervene to
assess the deteriorating patient and identify the deterioration through a rapid response system. The
registered nurses need to make collaborative efforts with ICU liaison nurses to involve rapid response
team and incorporate medical emergency responsibilities(Safetyandquality.gov.au, 2019). The ethical

and legal concerns should be given priority while providing critical care approach to these deteriorating
patients. The Code of Ethics, Quality of care policies, confidentiality policies and Right based patient
constitutions should be incorporated as ethical and legal considerations. The registered nurses should
have a prior knowledge of complementary therapies and effective treatment combinations that would
enable a patient to recover from deteriorating symptoms.Dapagliflozin, incombination with insulin can
be used as effectively to improve the acidosis conditions in patients (Storgaard et al., 2016).
CONCLUSION
It is incumbent on the registered nurses to advance their knowledge about the disease pathophysiology
prior to treating the deteriorating patients. The registered nurses should enhance their knowledge on
rapid response system administration. They should provide clear communication with the response
team and include collaborative strategies during rapid response management. The ethical and legal
policies in patient centered care in critical care environment should be considered by registered
nurses.The national medicines policy should be followed by registered nurses in response to providing
effective drugs that are needed to improve the deteriorating symptoms.The medical emergency criteria
of airway obstructions, circulatory problems, and neurological problems should be checked for calling
rapid response team. The registered nurses should include pharmacokinetic treatment strategies like
combination of drugs to treat diabetic ketoacidosis.
REFERENCE LIST
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). GarciniaCambogia, 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.
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, 191, 324-330.
Møller, N. (2017). Acute Metabolic Complications of Diabetes: Diabetic Ketoacidosis and the
Hyperosmolar Hyperglycemic State. Textbook of Diabetes, 534-539.
Moore, L. E. (2018). Diabetic Ketoacidosis. In Diabetes in Pregnancy (pp. 127-136). Springer,
Cham.
Mousa, S. O., Sayed, S. Z., Moussa, M. M., & Hassan, A. H. (2017). Assessment of platelets
morphological changes and serum butyrylcholinesterase activity in children with diabetic
ketoacidosis: a case control study. BMC endocrine disorders, 17(1), 23.
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia - New codes
of conduct for nurses and midwives published. Retrieved from
https://www.nursingmidwiferyboard.gov.au/news/2017-09-28-new-codes-of-
conduct.aspx
Oecd.org. (2019). Health policy in Australia. Retrieved from
http://www.oecd.org/australia/Health-Policy-in-Australia-December-2015.pdf
Ogawa, W., &Sakaguchi, K. (2016). Euglycemic diabetic ketoacidosis induced by SGLT2
inhibitors: possible mechanism and contributing factors. Journal of diabetes
investigation, 7(2), 135-138.
Safetyandquality.gov.au. (2019). Recognising and Responding to Clinical Deterioration | Safety
and Quality. Retrieved from

https://www.safetyandquality.gov.au/our-work/recognising-and-responding-to-
clinical-deterioration/
Soto-Rivera, C. L., Asaro, L. A., Agus, M. S., &DeCourcey, D. D. (2017). Suspected Cerebral
Edema in Diabetic Ketoacidosis: Is there still a role for Head CT in treatment
decisions?.Pediatric critical care medicine: a journal of the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care Societies,
18(3), 207.
Storgaard, H., Bagger, J. I., Knop, F. K., Vilsbøll, T., &Rungby, J. (2016). Diabetic Ketoacidosis
in a Patient with Type 2 Diabetes After Initiation of Sodium–Glucose Cotransporter 2
Inhibitor Treatment. Basic & clinical pharmacology & toxicology, 118(2), 168-170.
Sulimani, R. A., Jammah, A. A., Ghozzi, I. M., Alotair, H. A., Al-Mohaya, S. A., &Ashour, T. E.
(2018). Cerebral injury in diabetic ketoacidosis: Is there a room for conservative
management?.Journal of Nature and Science of Medicine, 1(2), 82.
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