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Does Ketoacidosis Cause Hypokalemia

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Why Is There Hyperkalemia In Diabetic Ketoacidosis?

Lack of insulin, thus no proper metabolism of glucose, ketones form, pH goes down, H+ concentration rises, our body tries to compensate by exchanging K+ from inside the cells for H+ outside the cells, hoping to lower H+ concentration, but at the same time elevating serum potassium. Most people are seriously dehydrated, so are in acute kidney failure, thus the kidneys aren’t able to excrete the excess of potassium from the blood, compounding the problem. On the other hand, many in reality are severely potassium depleted, so once lots of fluid so rehydration and a little insulin is administered serum potassium will plummet, so needs to be monitored 2 hourly - along with glucose, sodium and kidney function - to prevent severe hypokalemia causing fatal arrhythmias, like we experienced decades ago when this wasn’t so well understood yet. In practice, once the patient started peeing again, we started adding potassium chloride to our infusion fluids, the surplus potassium would be peed out by our kidneys so no risk for hyperkalemia. Continue reading >>

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  1. kirabatgirl

    Ketoacidosis, Hypokalemia, Lowered A1c, and normal fasting blood sugar

    Greetings everyone,
    On July 20, 2016 I was diagnosed with type two diabetes. My A1c was 6.5 and my blood sugar was possibly high because I was eating tons of carbs that day. Of course, I asked my doctor if he was sure and he simply stated, "You have a history of diabetes in your family (father), you are over weight (5,4'', 213lbs), and your A1c is 6.5." He was really cold about it. I asked him if I could make necessary changes and reverse the diabetes. He said, "No, but you are in control and you can manage it, but it is progressive." He immediately prescribed me 1000mg of Metformin twice a day and I took it as expected.
    I began Metformin on the 23rd of July 20, 2016. I had extreme adverse reaction to the drug. I could not eat to save my life. I felt as if I was pregnant with morning sickness. I continued life as normal; holding my nose and gulping kale smoothies to give myself some kind of nutrients. I eventually couldn't do anything and asked a friend to stay with me and watch over me. I returned to my doctor on July 25, 2016 (glucose was 73) and he told me to take two Metformin pills at night instead of one pill twice a day. I immediately began crying because I couldn't sleep due to sick stomach from taking one pill. I asked for another blood test and he reassured me that the test will not change within a couple of days.
    I left with the issue unresolved. On the 27, of July I began to experience brain fog. I was alone with my 7 year old daughter and I said to myself enough is enough, I don't feel well. I called a friend and went to the hospital where I was admitted. I was experiencing chest tightness and a fast unnatural heartbeat so I was given an EKG and Ultrasound to check my kidneys, liver, and pancreas. Everything came back normal until my blood work came in. My Anion Gap was 22, My potassium was 2.9. My blood was highly acidic... Oh, and my A1c was 6.1. Huh? I don't know, but even the emergency room physician said that my blood sugar was normal and she felt that the doctor should do a little more testing before diagnosing me right away. Anywho, I was administered IV after IV and had blood drawn about 3 times. I have a lot of bruising in my arm because of it.
    On the 28th, I was sent to the stroke ward because the hospital was full to capacity. While there, I gave a lot of blood and all of my glucose tests were normal. I asked my nurses their opinion and all of them were like, if you were even pre-diabetic, you are diabetic. All except for one. She was an older lady who's husband has diabetes and had it for years. She just felt that it was weird my fasting blood sugar was always within range the whole stay. The other nurses mentioned that it was because I only ate broth, and I believed them. So, once they introduced me to solid foods, they claimed I didn't eat enough. I tried to explain that I haven't eaten for a week and my stomach has shrunk. I eat, but my apatite is not that much. I was fed non diabetic food and still stayed within range. My glucose test never rose above 110 and the only reason it reached 110 was because my nurse forced me to eat graham crackers and apple juice because my glucose was 83.
    Any who, I became very discouraged because my doctor refused to listen to my needs. She was extremely heartless and I understand that her job could be stressful, but she didn't care that my bp rose to severe levels (the nurse called her, she didn't come), and she could care less about retesting me for diabetes. I even told her I could not take full breaths and she turned a blind eye. I felt better with the first physician in the emergency room. I could tell that she really care and have a heart for her patients. So much so, I gave her a hug!
    I was released on July 30, 2016 with chest tightness, Potassium 3.3L(Still low), and light headedness. She told me that my levels will return to normal even though they increased and dropped continuously. I asked for potassium pills just in case and she wrote me a prescription for 2. That may be the only nice thing she did for me while I was there. I left the hospital with the diagnosis of : Ketoacidosis (not dka), Hypokalemia, At risk for blood clots.... What?????? Axiety and bp increased once I saw that. I prayed, calmed myself down, and told myself that I am going to get to the bottom of this. If I am diabetic, I am diabetic and I will deal with it... If I am pre-diabetic, I'd feel a lot better because it's not diabetic. I want the right diagnosis. I want to recover from low potassium, and I want my blood at normal alkaline levels. I will shoot for these goals.
    What upsets me is that humans have errors at times, machines have errors also. Before you diagnose a person, know for sure... You always trust, but verify!
    I hope everyone stay blessed! Peace, Happiness, and everlasting light!
    Quick note, I weighed 213 on the 20th... After taking Metformin, I weighed 208 by the 25th. Crazy!

  2. Seagal

    Welcome to the forum.
    Sorry you've been through the wringer, but Metformin has that reaction with some folks and sometimes it gets better with time and sometimes not.
    I guess they didn't want you to go low when they gave you graham crackers & juice with a perfectly fine "83", but they get fearful about that.
    If you don't have a meter & strips get some at Walmart (Relion) and start testing your fasting, pre-meal and 1-2 hours after a meal. Log your numbers and then you will have something to show the doctor when you ask for another test. Perhaps you could ask for an OGTT, plus another A1c.
    Until you get retested, manage your b.g. as though you are diabetic and go from there.

  3. chalup

    Wow, I would seriously consider finding another doctor if I was you.

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