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Why Does Ketoacidosis Cause Hypokalemia

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Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome

In Brief Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Mortality rates are 2–5% for DKA and 15% for HHS, and mortality is usually a consequence of the underlying precipitating cause(s) rather than a result of the metabolic changes of hyperglycemia. Effective standardized treatment protocols, as well as prompt identification and treatment of the precipitating cause, are important factors affecting outcome. The two most common life-threatening complications of diabetes mellitus include diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction in the net effective concentration of circulating insulin coupled with a concomitant elevation of counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). These hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. DKA is reported to be responsible fo Continue reading >>

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  1. Hipp

    In response to the thread for hypokalemia. I noticed diabetic ketoacidosis is mentioned as one of the causes of hypokalmia in that thread.
    Ketoacidosis is more associated with hyperkalemia not hypokalemia. In management of ketoacidosis giving insulin cause hypokalemia by shifting potassium inside the cells.

  2. tommyk

    According to all sources that I am familiar with, in Diabetic Ketoacidosis, replenishing K+ is a key factor. I think you are referring to the "falsely elevated potassium" that can initially result with DKA. With the acidosis and dehydration, patients become potassium depleted. The committment acidosis will contribute to "shifting" potassium out of the cell giving you a falsely elevated potassium. The danger is if a patient is severly potassium depleted in the face of an acidosis, with the fluids correcting the acidosis, the insulin is going to shove more potassium into the cells thus acutely lowering the serum potassium level to potentially dangerous levels. If the potassium gets lower than 2.0-2.5 one is prone to provoking lethal arrhythmias.
    --Tommyk

  3. tommyk

    TOTAL BODY Potassium deficits are high in DKA even with paradoxically high K+ due to acidotic state, which shifts H+ into cells and K+ out of cells into blood. To reiterate, the K+ is PARADOXICALLY high, not truly high. Due to the dehydration, they WILL need potassium during the treatment. This can be a great trick the boards can pull on you to make you pick the wrong answer.
    However, you bring up a great point about the inital paradoxical effect. Still, Diabetic Ketoacidosis DOES cause hypokalemia. Patients with DKA have marked fluid and electrolyte deficits. They commonly have a fluid deficit of nearly 100ml/kg, and need several hundred millimoles of potassium ion (3-5+mmol/kg) and sodium (2-10mmol/kg), as well as being deficient in phosphage (1+ mmol/kg), and magnesium. Replacement of these deficits is made more difficult due to a variety of factors, including the pH derangement that goes with DKA. Mainly in children, an added concern is the uncommon occurrence of cerebral oedema, thought by some to be related to hypotonic fluid replacement.
    Hipp, there are several mechanisms for fluid depletion in DKA. These include osmotic diuresis due to hyperglycemia, the vomiting commonly associated with DKA, and, eventually, inability to take in fluid due to a diminished level of consciousness. Electrolyte depletion is in part related to the osmotic diuresis. Potassium loss is also due to the acidotic state, and the fact that, despite total body potassium depletion, serum potassium levels are often high, predisposing to renal losses. Does this all make sense?
    Thanks for listening,
    Tommyk

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