DKA help

smf0903 · Apr 22, 2015

Think about the s/sx that a patient with DKA presents with. What is the body doing to try to compensate? The ABG will make sense :)

Alisonisayoshi, LVN · Apr 22, 2015

They have kussmals, so they are blowing off CO2, and they vomit and are dehydrated which can lead to metabolic alkalosis so it's a compensation mechanism that is causing the labs?

Alisonisayoshi, LVN · Apr 22, 2015

Think about the s/sx that a patient with DKA presents with. What is the body doing to try to compensate? The ABG will make sense :)

Thank you!

chare · Apr 22, 2015

I agree with you regarding the ABG results, as these make no sense. To be in DKA you have to be acidotic, not alkalotic. By definition, this means a pH of

RN2800 · May 8, 2015

Yes, its still DKA, and the AG you calculated in not accurate, its 20 and not 14. The Pt has overcompensated by blowing off CO2. The bicarb is normally lower. Sounds like a Pt on day 2 or day three whose kideneys have responded and recovering bicarb gain. I like what the other nurse said about nausea and vomiting. Its a different metabolic process which is as simple as alkalosis due to H+ loss. When combined with a primary metabolic acidosis i can see how such a gas would cause confusion.

Thanks for posting.

nurseprnRN, BSN, RN · May 8, 2015

Does the analysis of the ABG say DKA, or was that the admitting diagnosis three days ago?

SopranoKris, MSN, RN, NP · May 9, 2015

Think about it this way: when your body compensates, the OTHER system kicks in. So, if the patient originally has metabolic acidosis, when the body starts compensating, you're going to see the respiratory system kick in to compensate. Yes, the pH is high, but BOTH PaCO2 & HCO3 are low. This tells you that it's partially compensated.

You have to look at ALL the S&Sx the pt is presenting, not just the ABGs. It's definitely confusing, when you're used to seeing DKA solely as metabolic acidosis. However, many patients don't come in until they're in really bad shape and they're already compensating. I had a DKA pt in clinicals who had similar labs. When I look at this person's ABGs, I did not expect it to look that way. My clinical instructor told me to think about it and figure out why the ABG would appear that way. Makes sense once you think through the compensation process :)

AnthonyD · May 9, 2015

Yes, while the patient's ABG shows and alkalemic state, they are still in DKA as evidenced by the anion gap acidosis.

Alisonisayoshi, LVN · May 9, 2015

Thank you all so much, I get it so much more now. Those were the labs drawn on admission of the pt. It makes much better sense after reading these responses.