Providing the best possible care: an overview of the current understanding of diabetic ketoacidosis.

Diabetic ketoacidosis remains a potentially fatal sequela of diabetes mellitus, despite advances in health care. Nurses, especially those in critical care areas, need to have a good understanding of the condition, including the physiological changes involved and treatment considerations. This paper reports on some of the literature relating to diagnosis, physiological changes and treatment that pertains to critical care nurses. Hyperglycaemia, ketosis and metabolic acidosis are indicative of the condition, with treatment directed towards reversal of dehydration, restoration of normoglycaemia and reversal of ketoacidosis, correction of electrolyte imbalances (especially hypokalaemia) and prevention of complications. Most important are constant monitoring and evaluation of the patient's condition and titration of treatment to individual needs. Nurses face the challenge of caring competently for the patient with DKA, which includes understanding the physiological changes as these influence management and treatment.