Quick ? about IDDM

Short answer: I'd want to see that acidosis corrected first---the blood-sugar level, while far from optimal, isn't critical, but that pH certainly is!

Using your knowledge of the pathophysiology of DM, what do you think may be causing the patient's acidosis? Is that a serious concern for a diabetic?

I wonder if the patient is beginning DKA due to his blood sugar at 268? Though DKA is usually over 300, I think I would give insulin first and redraw for ph.

Excellent article on Diabetic Ketoacidosis (DKA):

http://www.emedicine.com/PED/topic582.htm - PEDS
http://www.emedicine.com/med/topic548.htm - ADULTS

BS at near normal levels (at/about 250 and higher) indicates DKA. Pts. in DKA will be acidotic. Bicarb level(s) via ABGs is/are better indicator(s) of degree of acidosis.

Although showing acidosis in the above scenario, the pH is not the primary focus and not aggressively tx. Treat BS and pH (acidosis) will automatically improve. If not, may indicate inadequate tx with fluids and insulin. If evidence of ECG changes indicating cardiac contractility abnormalities secondary to acidosis, will be indication to address and tx appropriately.

Critical to address status of K+ prior to insulin administration. Never administer insulin before ascertaining the level of K+. Replace K+ if deficient for when you tx with insulin, the insulin forces K+ back into the cells and can result in hypokalemia.

SirI: Thanks for that great explanation. As an insulin-dependent diabetic as well as a pre-nursing student who studied acid-base balance in A&P II this spring, when I see questions like this I try to "test" myself a bit. And, I was right on according to your answer. Now if only I could guarantee this question to be on the NCLEX!