This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
Patient at the center of the map
The patient is illustrative. Mr. D., 24, has type 1 diabetes and has had vomiting for a day. He stopped taking his insulin because he "wasn't eating." He arrives breathing deeply and quickly, with a fruity smell on his breath. His glucose is 486 mg/dL, pH 7.12, bicarbonate 10 mmol/L and β-hydroxybutyrate 5.8 mmol/L.
Diagnostic criteria
The 2024 consensus report on hyperglycemic crises defines diabetic ketoacidosis (DKA) by three findings: glucose of 200 mg/dL or more (or a prior diabetes diagnosis, whatever the glucose), raised ketones (β-hydroxybutyrate of 3.0 mmol/L or more, or urine ketones 2+ or more), and metabolic acidosis (pH below 7.3 and/or bicarbonate below 18 mmol/L). The lower glucose threshold recognizes that DKA can occur with near-normal glucose, for example in people taking SGLT2 inhibitors (Umpierrez et al., 2024).
The concept map
Insulin deficiency (the central problem)
- → Cells can't take up glucose → the liver makes more glucose → hyperglycemia
- → glucose spills into the urine and pulls water with it (osmotic diuresis) → dehydration: dry mucous membranes, tachycardia, low blood pressure, low urine output later
- → Nursing priority 1: restore circulating volume with intravenous fluids as ordered; strict intake and output; hourly vital signs
- → Fat breaks down for fuel → ketone production → metabolic acidosis
- → the body blows off CO₂ → Kussmaul respirations; acetone breath
- → nausea, vomiting and abdominal pain
- → Nursing priority 2: give insulin as ordered (usually a continuous intravenous infusion) to stop ketone production; monitor glucose every hour
- → Potassium shifts out of cells while the kidneys lose it in the urine → serum potassium may look normal or high while total body potassium is low
- → insulin drives potassium back into cells → risk of hypokalemia and dysrhythmias
- → Nursing priority 3: check potassium before starting insulin and replace it as ordered; continuous cardiac monitoring
Pharmacology links
| Drug | Why it's given | Nursing checks |
|---|---|---|
| Isotonic crystalloid (0.9% saline or a balanced solution) | Restores volume and kidney perfusion | Lung sounds, intake and output, blood pressure |
| Regular insulin infusion | Stops ketogenesis and lowers glucose | Hourly glucose; add dextrose to fluids as glucose falls so insulin can continue until ketoacidosis resolves |
| Potassium chloride | Replaces total body potassium | Potassium level, urine output, cardiac rhythm |
Evaluation and teaching
The nurse watches for resolution (ketones falling, the anion gap closing, bicarbonate and pH rising) and for complications of treatment, such as hypoglycemia and hypokalemia. Before discharge, teaching focuses on sick-day rules: never stop basal insulin, check glucose and ketones more often when ill, keep drinking fluids, and call the care team early if vomiting continues.
Reference
Umpierrez, G. E., Davis, G. M., ElSayed, N. A., Fadini, G. P., Galindo, R. J., Hirsch, I. B., Klonoff, D. C., McCoy, R. G., Misra, S., Gabbay, R. A., Bannuru, R. R., & Dhatariya, K. K. (2024). Hyperglycemic crises in adults with diabetes: A consensus report. Diabetes Care, 47(8), 1257–1275. https://doi.org/10.2337/dci24-0032
