The patient is in a diabetic ketoacidosis (DKA) state if the following conditions apply: (a) Hyperglycemia—blood glucose > 11mmol/L, and (b) Metabolic acidosis— venous pH < 7.3 or plasma HCO3 < 15 mmol/L plus (c) ketosis—ketones in the blood or urine or beta-hydroxybutyrate concentration > 3 mmol/L (Wolfsdorf et al., 2014). The patient’s deep respirations are perfectly normal given the condition of the patient: the respirations are explained by the lungs working to expel CO2 from the body. The body does not want CO2 levels to rise too highly, which happens during the event of ketoacidosis.
Because the patient is a type 1 diabetic—also known as a juvenile diabetic as Type 1 is found primarily in children and young adults—the condition with which the patient has presented is most likely diabetic ketoacidosis, probably caused by an illness or infection which compels the body to produce more hormones (adrenaline, cortisol) to fight the infection. The problem is that the hormones counteract the insulin’s work, which is to help cells absorb blood sugar. If the hormones prevent the insulin from doing its job, the blood glucose levels will rise sharply because the body’s cells are not absorbing them. This will trigger commonly a DKA.
The arterial blood gases (ABGs) likely to be seen in this state, therefore,...
DKA pH would be around 7.36 for a mild DKA, and PaCO2 would be 25 mm Hg. The carbon dioxide level is explained by the fact that the patient’s body is implementing a compensatory mechanism because of the metabolic acidosis. Blowing off CO2 (acid)—i.e., releasing carbon dioxide from the lungs via Kussmaul respirations (hyperventilation in an attempt to compensate for the acidosis)—is the body’s line of defense. HCO3 would be 9 mEq/L in a mild DKA. The patient would be in metabolic acidosis, fully compensated.
One likely explanation for what happened is that the patient probably had an infection prior to getting sick with the diabetic ketoacidosis. The patient’s mother might be in a position to confirm or deny this hypothesis. Even if unknown, to the mother, a quick examination of the anion gap would help to clarify the state of the patient’s helath with respect to acidosis severity. The hyperventilation is compensation for the acidosis and should not be viewed as a cause of immediate concern for the mother or the nurse. The patient has ketonuria (a high amount of ketone bodies in the urine), anorexia, nausea, abdominal pain, thirst, and polyuria. Bicorbanate could be used to facilitate the CO2 reduction process, but this is not without its own risks: as Leung,…
