A client is admitted with Diabetic Ketoacidosis (DKA). The client asks the nurse “Why did this happen? I have been taking my insulin as prescribed and following my diet carefully” The nurse reviews the client’s chart and realizes that this emergency may be related to which common causes of DKA?
A.
Client is taking Ibuprofen and has a history of gastric ulcers.
B.
Clent is taking Glipizide and has a history of hypoglycemia.
C.
Client is taking Prednisone and recovering from a urinary tract infection.
D.
Client is taking Metoprolol and has peripheral neuropathy.
The Correct answer and Explanation is:
The correct answer is C. Client is taking Prednisone and recovering from a urinary tract infection.
Explanation:
Diabetic Ketoacidosis (DKA) is a serious complication of diabetes characterized by hyperglycemia, metabolic acidosis, and ketonuria. It most commonly occurs in patients with type 1 diabetes but can also occur in those with type 2 diabetes under certain conditions. Understanding the precipitating factors is crucial for managing and preventing DKA.
In this scenario, the client is taking prednisone, a corticosteroid, which is known to raise blood glucose levels. Corticosteroids can induce insulin resistance, leading to increased hepatic glucose production and reduced peripheral glucose uptake. This effect can precipitate DKA, especially if the client is under stress, such as recovering from an infection like a urinary tract infection (UTI). Infections increase metabolic demand and can lead to a greater requirement for insulin. If the patient’s insulin dosage is not adjusted to meet this increased demand due to the stress of illness, hyperglycemia may develop, potentially leading to DKA.
The other options do not present the same level of risk for precipitating DKA:
- A. Ibuprofen and a history of gastric ulcers: While NSAIDs like ibuprofen can affect gastric mucosa, they are not directly associated with precipitating DKA.
- B. Glipizide and a history of hypoglycemia: Glipizide is an oral hypoglycemic agent that stimulates insulin release. While hypoglycemia is a concern, it is not a common cause of DKA.
- D. Metoprolol and peripheral neuropathy: Metoprolol is a beta-blocker primarily used for hypertension and cardiac conditions. It does not directly contribute to DKA and is not associated with worsening glycemic control.
In summary, the use of prednisone, particularly when coupled with an infection, is a significant risk factor for DKA in this client, making option C the correct choice.