The Clinical Caveat for Treating Persistent Hypokalemia in Diabetic Ketoacidosis

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2023 Aug 22

PMID 37605707

Authors

Bashar Khiatah

Amanda Frugoli

Deborah Carlson

Affiliations

Soon will be listed here.

Abstract

The medical community seeks to provide evidence-based guidelines for treating any disease to ensure optimal care delivery. Occasionally, a patient's unique physiology does not respond to guideline-driven treatments and requires experienced clinical personalization for treatment. Failure of clinicians to recognize patient outliers and augment care can delay treatment, provide substandard care, and potentially threaten a patient's life. This paper describes a clinical caveat for treating profound or persistent hypokalemia in patients with DKA (diabetic ketoacidosis).

References

Hursh B, Ronsley R, Islam N, Mammen C, Panagiotopoulos C . Acute Kidney Injury in Children With Type 1 Diabetes Hospitalized for Diabetic Ketoacidosis. JAMA Pediatr. 2017; 171(5):e170020. DOI: 10.1001/jamapediatrics.2017.0020. View

Pasquel F, Tsegka K, Wang H, Cardona S, Galindo R, Fayfman M . Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study. Diabetes Care. 2019; 43(2):349-357. PMC: 6971788. DOI: 10.2337/dc19-1168. View

Dhatariya K, Nunney I, Higgins K, Sampson M, Iceton G . National survey of the management of Diabetic Ketoacidosis (DKA) in the UK in 2014. Diabet Med. 2015; 33(2):252-60. DOI: 10.1111/dme.12875. View

Palmer B, Clegg D . Electrolyte and Acid-Base Disturbances in Patients with Diabetes Mellitus. N Engl J Med. 2015; 373(6):548-59. DOI: 10.1056/NEJMra1503102. View

Syed Z, Kimball T, Ismail M . Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient. Case Rep Crit Care. 2019; 2019:6130694. PMC: 6710747. DOI: 10.1155/2019/6130694. View

Kitabchi A, Umpierrez G, Miles J, Fisher J . Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009; 32(7):1335-43. PMC: 2699725. DOI: 10.2337/dc09-9032. View

BURNELL J, Scribner B, UYENO B, VILLAMIL M . The effect in humans of extracellular pH change on the relationship between serum potassium concentration and intracellular potassium. J Clin Invest. 1956; 35(9):935-9. PMC: 441665. DOI: 10.1172/JCI103352. View

BEIGELMAN P . Potassium in severe diabetic ketoacidosis. Am J Med. 1973; 54(4):419-20. DOI: 10.1016/0002-9343(73)90037-5. View

Umpierrez G, Korytkowski M . Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016; 12(4):222-32. DOI: 10.1038/nrendo.2016.15. View

10.

Dhatariya K, Glaser N, Codner E, Umpierrez G . Diabetic ketoacidosis. Nat Rev Dis Primers. 2020; 6(1):40. DOI: 10.1038/s41572-020-0165-1. View

11.

Abramson E, Arky R . Diabetic acidosis with initial hypokalemia. Therapeutic implications. JAMA. 1966; 196(5):401-3. View

12.

Miles J, Rizza R, Haymond M, Gerich J . Effects of acute insulin deficiency on glucose and ketone body turnover in man: evidence for the primacy of overproduction of glucose and ketone bodies in the genesis of diabetic ketoacidosis. Diabetes. 1980; 29(11):926-30. DOI: 10.2337/diab.29.11.926. View

13.

Wolfsdorf J, Craig M, Daneman D, Dunger D, Edge J, Lee W . Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes. 2009; 10 Suppl 12:118-33. DOI: 10.1111/j.1399-5448.2009.00569.x. View

14.

Murthy K, Harrington J, Siegel R . Profound hypokalemia in diabetic ketoacidosis: a therapeutic challenge. Endocr Pract. 2005; 11(5):331-4. DOI: 10.4158/EP.11.5.331. View

15.

Kitabchi A, Umpierrez G, Murphy M, Barrett E, KREISBERG R, Malone J . Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001; 24(1):131-53. DOI: 10.2337/diacare.24.1.131. View

16.

Balasse E, Fery F . Ketone body production and disposal: effects of fasting, diabetes, and exercise. Diabetes Metab Rev. 1989; 5(3):247-70. DOI: 10.1002/dmr.5610050304. View

17.

Arora S, Cheng D, Wyler B, Menchine M . Prevalence of hypokalemia in ED patients with diabetic ketoacidosis. Am J Emerg Med. 2011; 30(3):481-4. DOI: 10.1016/j.ajem.2011.01.002. View

18.

EXTON J . Gluconeogenesis. Metabolism. 1972; 21(10):945-90. DOI: 10.1016/0026-0495(72)90028-5. View