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Paradoxical Hyperkalemia In Dka

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Sodium Bicarbonate

Indications Metabolic Acidosis Diabetic Ketoacidosis (DKA) (see Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State) Indications: pH <6.9-7.0 (however, evidence for this recommendation is lacking) Patients with Hemodynamic Compromise (Due to Impaired Myocardial Contractility and Vasodilation) or Life-Threatening Hyperkalemia May Particularly Benefit from Bicarbonate Administration to Correct the pH Lactic Acidosis (see Lactic Acidosis) Adverse Effects of Acidemia: these (selected adverse effects) provide a rationale for administering bicarbonate with pH <7.1 Arrhythmias Arterial Vasodilation and Venoconstriction Decreased Left Ventricular Contractility Impaired Responsiveness to Catecholamine Vasopressors (Nat Rev Nephrol, 2012) [MEDLINE] Indications: pH <7.1 (however, evidence for this recommendation is lacking) This is due to the fact that at pH <7.1, small changes in pCO2 and serum bicarbonate result in large changes in the serum pH Clinical Efficacy: neither of these trials demonstrated clinical benefit with bicarbonate administration in patients with pH >7.1 Trial of Sodium Bicarbonate in Critically Ill Patients with Lactic Acidosis (Ann Intern Med, 1990) [MEDLINE] Sodi Continue reading >>

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  1. crush1staid - 01/17/10 19:33

    well u know half the answer , there is shift from intra to extra cellular ,thus the patient will have Hyper K and when we treat DKA we MUST give the maintance of K bcz insulin will shift K to inra cellular.
    If not giving K with tx then we will produce Hypo K .
    In ICU treating DKA ,K started after making sure pt is urinating.
    I hope this will help.

  2. studyin4ck - 01/18/10 04:29

    so is it right to say total body pottasium is decreased but serum potassium is increased.

  3. eurogirl - 01/19/10 09:40

    You are right guest123, this is the thing!

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What is ENDOCRINOLOGY? ENDOCRINOLOGY meaning - ENDOCRINOLOGY pronunciation - ENDOCRINOLOGY definition - ENDOCRINOLOGY explanation - What does ENDOCRINOLOGY mean? How to pronounce ENDOCRINOLOGY? Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license.

Endocrinology

Start Quiz! Xray findings decreased bone density with thinning of cortex and pseudofractures (Looser zones) 1) Post-surgical (most common cause) 2) Autoimmune 3) Congenital absence or maldevelopment of the parathyroid glands (eg DiGeorge syndrome) 4) Defective calcium-sensing receptor on the parathyroid glands 5) Non-autoimmune destruction of parathyroid gland due to infiltrative diseases (hemochromatosis, Wilson disease, neck irradiation) Continue reading >>

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  1. metalmd06

    Does acute DKA cause hyperkalemia, or is the potassium normal or low due to osmotic diuresis? I get the acute affect of metabolic acidosis on potassium (K+ shifts from intracellular to extracellular compartments). According to MedEssentials, the initial response (<24 hours) is increased serum potassium. The chronic effect occuring within 24 hours is a compensatory increase in Aldosterone that normalizes or ultimatley decreases the serum K+. Then it says on another page that because of osmotic diuresis, there is K+ wasting with DKA. On top of that, I had a question about a diabetic patient in DKA with signs of hyperkalemia. Needless to say, I'm a bit confused. Any help is appreciated.

  2. FutureDoc4

    I remember this being a tricky point:
    1) DKA leads to a decreased TOTAL body K+ (due to diuresis) (increase urine flow, increase K+ loss)
    2) Like you said, during DKA, acidosis causes an exchange of H+/K+ leading to hyperkalemia.
    So, TOTAL body K+ is low, but the patient presents with hyperkalemia. Why is this important? Give, insulin, pushes the K+ back into the cells and can quickly precipitate hypokalemia and (which we all know is bad). Hope that is helpful.

  3. Cooolguy

    DKA-->Anion gap M. Acidosis-->K+ shift to extracellular component--> hyperkalemia-->symptoms and signs
    DKA--> increased osmoles-->Osmotic diuresis-->loss of K+ in urine-->decreased total body K+ (because more has been seeped from the cells)
    --dont confuse total body K+ with EC K+
    Note: osmotic diuresis also causes polyuria, ketonuria, glycosuria, and loss of Na+ in urine--> Hyponatremia
    DKA tx: Insulin (helps put K+ back into cells), and K+ (to replenish the low total potassium
    Hope it helps

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This animated video presentation is about potassium regulation and the pathophsyiology of hyperkalemia to make it easy to follow and understand the causes and the management of Hyperkalemia. email : [email protected]

3,518 Possible Causes For Hyperkalemia + Ketonuria + Ketosis + Bicarbonate Increased + Metabolic Acidosis In Usa

Acidosis Hyperkalemia Bicarbonate Increased Ketonuria Ketosis It is due to the accumulation of ketoacids (via excessive ketosis) and reflects a severe shift from glycolysis to lipolysis for energy needs.[en.wikipedia.org] Causes: Metabolic Acidosis and Elevated Anion Gap (Mnemonic: "MUD PILERS") Methanol , Metformin Uremia Diabetic Ketoacidosis (DKA), Alcohol ic ketoacidosis or starvation ketosis[fpnotebook.com] An increase in the production of other acids may also produce metabolic acidosis.[en.wikipedia.org] Hyperkalemia (hyperpotassemia) is the presence of an abnormally high concentration of potassium in the blood. Ketosis is a condition characterized by elevated levels of ketone bodies (β-hydroxybutyric acid, acetoacetic acid, acetone) in the body. Acidosis Bicarbonate Decreased Bicarbonate Wasting Renal Tubular Acidosis Chronic Lactic Acidosis Distal Renal Tubular Acidosis Episodic Lactic Acidosis Episodic Metabolic Acidosis Hyperchloremic Metabolic Acidosis Hyperchloremic Metabolic Acidosis - HCO3 15.5 +- 2.0 mM Hyperkalemic Metabolic Acidosis Incomplete Distal Renal Tubular Acidosis Increased Basal Metabolic Rate Ketosis Is Exacerbated by Protein Ingestion Lactic Acidosis L Continue reading >>

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Popular Questions

  1. metalmd06

    Does acute DKA cause hyperkalemia, or is the potassium normal or low due to osmotic diuresis? I get the acute affect of metabolic acidosis on potassium (K+ shifts from intracellular to extracellular compartments). According to MedEssentials, the initial response (<24 hours) is increased serum potassium. The chronic effect occuring within 24 hours is a compensatory increase in Aldosterone that normalizes or ultimatley decreases the serum K+. Then it says on another page that because of osmotic diuresis, there is K+ wasting with DKA. On top of that, I had a question about a diabetic patient in DKA with signs of hyperkalemia. Needless to say, I'm a bit confused. Any help is appreciated.

  2. FutureDoc4

    I remember this being a tricky point:
    1) DKA leads to a decreased TOTAL body K+ (due to diuresis) (increase urine flow, increase K+ loss)
    2) Like you said, during DKA, acidosis causes an exchange of H+/K+ leading to hyperkalemia.
    So, TOTAL body K+ is low, but the patient presents with hyperkalemia. Why is this important? Give, insulin, pushes the K+ back into the cells and can quickly precipitate hypokalemia and (which we all know is bad). Hope that is helpful.

  3. Cooolguy

    DKA-->Anion gap M. Acidosis-->K+ shift to extracellular component--> hyperkalemia-->symptoms and signs
    DKA--> increased osmoles-->Osmotic diuresis-->loss of K+ in urine-->decreased total body K+ (because more has been seeped from the cells)
    --dont confuse total body K+ with EC K+
    Note: osmotic diuresis also causes polyuria, ketonuria, glycosuria, and loss of Na+ in urine--> Hyponatremia
    DKA tx: Insulin (helps put K+ back into cells), and K+ (to replenish the low total potassium
    Hope it helps

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