DKA vs. HHS Study Guide

DKA vs. HHS Study Guide Management Priorities Pathophysiology Feature DKA Insulin Status Absent or severely decreased Ketones Present Acidosis Yes – metabolic (↓ pH, ↓ HCO₃) Fat Metabolism Yes → ketone production Osmolality Mild ↑ HHS Ineffective or relatively deficient Absent or minimal No No Markedly ↑ (>350 mOsm/kg) Population & Onset Feature DKA Type of Diabetes Type 1 (any age) Common Triggers Infection, missed insulin, new onset DM Onset Rapid Lab Values Lab Glucose pH HCO₃ Ketones Serum Osmolality BUN/Cr pCO₂ DKA 300–800+ mg/dL <7.30 <15 Positive Mild ↑ ↑ (dehydration) 10–30 (resp. compensation) HHS Type 2 (older adults) Infection, thiazides, dialysis Gradual HHS >600 mg/dL Normal Normal Negative >350 ↑ (dehydration) Normal Clinical Features System DKA Neuro Alert → coma, headache, blurred vision Pulmonary Kussmaul respirations (deep, rapid) Cardiac Hypovolemia, weak pulses, tachycardia GI/GU Anorexia, N/V, abdominal pain, polyuria Skin Dry, flaky, poor turgor HHS Variable, seizures, hemiparesis None noted Profound hypotension, tachycardia Polyuria Same For Both: 1. Rehydrate (Start with NS → D5W when BG ≈ 300 mg/dL) 2. Replace Electrolytes (Monitor especially K⁺) 3. Administer Insulin (Regular IV) o DKA: for correcting acidosis & hyperglycemia o HHS: for correcting hyperglycemia only DKA Before Insulin: Fluids + electrolytes first to prevent hypovolemia & hypokalemia. Key Concerns Risk Fluid overload Hypokalemia Hypoglycemia Cerebral edema Why it Matters Aggressive fluid replacement can cause pulmonary edema Insulin + fluids can drop K⁺ drastically Overcorrection of glucose Rapid drop in glucose → fluid shift in brain Sick Day Rules (for DKA prevention) • Continue insulin even if not eating • Avoid NPO – consume carbs (juice, soda, jello) • Drink hourly • Check BG & ketones q3–4 hrs • Call provider: N/V/D or ketones ↑ Nursing Interventions • Strict I&O • Monitor electrolytes, especially K⁺ • Hourly vitals • Frequent neuro checks (GCS) • EKG monitoring (for K⁺ effects) • Lung sounds – watch for crackles • Daily weight & edema assessment Sample NCLEX-style Question Which ABG best represents DKA? D. pH 7.21, CO₂ 28, HCO₃ 16 → Metabolic acidosis with respiratory compensation