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Why Does Ketoacidosis Cause Hypokalemia

Profound Hypokalemia Associated With Severe Diabetic Ketoacidosis

Profound Hypokalemia Associated With Severe Diabetic Ketoacidosis

Go to: Abstract Hypokalemia is common during the treatment of diabetic ketoacidosis (DKA); however, severe hypokalemia at presentation prior to insulin treatment is exceedingly uncommon. A previously healthy 8-yr-old female presented with new onset type 1 diabetes mellitus, severe DKA (pH = 6.98), and profound hypokalemia (serum K = 1.3 mmol/L) accompanied by cardiac dysrhythmia. Insulin therapy was delayed for 9 h to allow replenishment of potassium to safe serum levels. Meticulous intensive care management resulted in complete recovery. This case highlights the importance of measuring serum potassium levels prior to initiating insulin therapy in DKA, judicious fluid and electrolyte management, as well as delaying and/or reducing insulin infusion rates in the setting of severe hypokalemia. Keywords: diabetic ketoacidosis, hypokalemia, insulin, low-dose insulin drip, pediatric Nearly one third of children with newly diagnosed type 1 diabetes present in diabetic ketoacidosis (DKA). Higher proportions of young children and those from disadvantaged socioeconomic groups present with DKA (1). DKA is the leading cause of mortality among children with diabetes, and electrolyte abnormalities are a recognized complication of DKA contributing to morbidity and mortality (2, 3). Total body potassium deficiency of 3-6 mEq/kg is expected at presentation of DKA due to osmotic diuresis, emesis, and secondary hyperaldosteronism; however, pretreatment serum potassium levels are usually not low due to the extracellular shift of potassium that occurs with acidosis and insulin deficiency (3, 4). After insulin treatment is initiated, potassium shifts intracellularly and serum levels decline. Replacement of potassium in intravenous fluids is the standard of care in treatment of DKA to prevent Continue reading >>

What Is Hypokalemia?

What Is Hypokalemia?

What is hypokalemia? Hypokalemia is the technical term for a low potassium level. Potassium, represented by K on the periodic table of elements, is one of the most important components of the blood. Mild hypokalemia is diagnosed with a serum potassium level less than 3.5 mEq/L, and severe hypokalemia is usually less than 2.5 mEq/L. This common condition has numerous causes; quite a few problematic symptoms; and standard, effective treatments. Causes of Hypokalemia The causes of hypokalemia fall into three categories: poor intake increased excretion and potassium shifts. Poor intake is rather easy to understand: the patient merely does not take in enough potassium. This may result from eating disorders, dental problems, and poverty. Failure to replace potassium can lead to symptoms ranging from mild to severe. Increased excretion of potassium is usually seen in the cases of vomiting and diarrhoea. In these conditions, the potassium is excreted far faster than the patient can replace it. Some medications, such as diuretics, can cause potassium loss. Excessive urination, such as that which occurs with diabetes, is another culprit. Perhaps more difficult to understand is the shift of fluids in the body that can cause a hypokalemic state. If a patient experiences paralysis for an extended period, potassium may leave the blood and leach into the interstitial space. High doses of insulin can also cause a potassium shift that decreases the availability of the nutrient in the blood. Finally, high doses of beta agonists commonly used in COPD are possible causes of low serum potassium. Symptoms of Hypokalemia As noted, symptoms can range from mild to severe, most falling in the mild category. In fact, many patients are hypokalemic for long periods and have few to no symptoms becau Continue reading >>

Cardiovascular Complications Of Ketoacidosis

Cardiovascular Complications Of Ketoacidosis

US Pharm. 2016;41(2):39-42. ABSTRACT: Ketoacidosis is a serious medical emergency requiring hospitalization. It is most commonly associated with diabetes and alcoholism, but each type is treated differently. Some treatments for ketoacidosis, such as insulin and potassium, are considered high-alert medications, and others could result in electrolyte imbalances. Several cardiovascular complications are associated with ketoacidosis as a result of electrolyte imbalances, including arrhythmias, ECG changes, ventricular tachycardia, and cardiac arrest, which can be prevented with appropriate initial treatment. Acute myocardial infarction can predispose patients with diabetes to ketoacidosis and worsen their cardiovascular outcomes. Cardiopulmonary complications such as pulmonary edema and respiratory failure have also been seen with ketoacidosis. Overall, the mortality rate of ketoacidosis is low with proper and urgent medical treatment. Hospital pharmacists can help ensure standardization and improve the safety of pharmacotherapy for ketoacidosis. In the outpatient setting, pharmacists can educate patients on prevention of ketoacidosis and when to seek medical attention. Metabolic acidosis occurs as a result of increased endogenous acid production, a decrease in bicarbonate, or a buildup of endogenous acids.1 Ketoacidosis is a metabolic disorder in which regulation of ketones is disrupted, leading to excess secretion, accumulation, and ultimately a decrease in the blood pH.2 Acidosis is defined by a serum pH <7.35, while a pH <6.8 is considered incompatible with life.1,3 Ketone formation occurs by breakdown of fatty acids. Insulin inhibits beta-oxidation of fatty acids; thus, low levels of insulin accelerate ketone formation, which can be seen in patients with diabetes. Extr Continue reading >>

Why Is There Hyperkalemia In Diabetic Ketoacidosis?

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 >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Practice Essentials Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria. Signs and symptoms The most common early symptoms of DKA are the insidious increase in polydipsia and polyuria. The following are other signs and symptoms of DKA: Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite, and anorexia History of failure to comply with insulin therapy or missed insulin injections due to vomiting or psychological reasons or history of mechanical failure of insulin infusion pump Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but may occur when the condition is neglected or with severe dehydration/acidosis Signs and symptoms of DKA associated with possible intercurrent infection are as follows: See Clinical Presentation for more detail. Diagnosis On examination, general findings of DKA may include the following: Characteristic acetone (ketotic) breath odor In addition, evaluate patients for signs of possible intercurrent illnesses such as MI, UTI, pneumonia, and perinephric abscess. Search for signs of infection is mandatory in all cases. Testing Initial and repeat laboratory studies for patients with DKA include the following: Serum electrolyte levels (eg, potassium, sodium, chloride, magnesium, calcium, phosphorus) Note that high serum glucose levels may lead to dilutional hyponatremia; high triglyceride levels may lead to factitious low glucose levels; and high levels of ketone bodies may lead to factitious elevation of creatinine levels. Continue reading >>

Prevalence Of Hypokalemia In Ed Patients With Diabetic Ketoacidosis

Prevalence Of Hypokalemia In Ed Patients With Diabetic Ketoacidosis

Abstract Although patients with diabetic ketoacidosis (DKA) are expected to have total body potassium depletion, measured levels may be normal or elevated due to extracellular shifts of potassium secondary to acidosis. Because insulin therapy decreases serum potassium levels, which creates potential to precipitate a fatal cardiac arrhythmia in a patient with hypokalemia, the American Diabetes Association (ADA) recommends obtaining a serum potassium level before giving insulin. Although the ADA guidelines are clear, the evidence on which they are based is largely anecdotal. The purpose of this study was to estimate the prevalence of hypokalemia in patients with DKA before initiation of fluid resuscitation and insulin therapy. This is a prospective cross-sectional descriptive study of patients with a capillary blood glucose level of 250 mg/dL or higher (at risk for DKA) seen in an urban county emergency department over a 1-year period. Those who consented provided basic demographic information and had a venous blood gas and chemistry panel drawn. Diabetic ketoacidosis and hypokalemia were defined using ADA recommendations. The mean age in our sample was 40.2 years, and 81% of patients were Hispanic. Of 503 analyzable patients with hyperglycemia, 54 (10.7%) met all criteria for DKA. Of patients with DKA, 3 (5.6%) of 54 (95% confidence interval, 1.2%-15.4%) had hypokalemia. Two of these patients had values of 3.0 mmol/L, and 1 had a value of 2.8 mmol/L. Hypokalemia was observed in 5.6% of patients with DKA. These findings support the ADA recommendation to obtain a serum potassium before initiating intravenous insulin therapy in a patient with DKA. Continue reading >>

A Case Of Successful Rescue Of Cardiac Arrest Caused Bydiabetic Ketoacidosis Combined With Hypokalemia

A Case Of Successful Rescue Of Cardiac Arrest Caused Bydiabetic Ketoacidosis Combined With Hypokalemia

A Case of Successful Rescue of Cardiac Arrest Caused byDiabetic Ketoacidosis Combined with Hypokalemia Zheng Yun-jiang*, Zhang Yun and Xie Yi-ying Department of Emergency Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, China *Corresponding author: Yun-Jiang Zheng, Department ofEmergency Medicine, ChongmingBranch, Xin Hua Hospital, ShanghaiJiao Tong University School ofMedicine, 25 South Gate Street,Chongming, Shanghai, 202150, China Cite this article as: Yun-jiang Z, Yun Z, Yi-ying X. A Caseof Successful Rescue of Cardiac ArrestCaused by Diabetic KetoacidosisCombined with Hypokalemia. Ann ClinCase Rep. 2017; 2: 1437. A 19-year-old male patient was hospitalized with coma with extremely high blood sugar levels. Low blood potassium, shock, acidosis and cardiac arrest in the course of disease, the rescue is successfulbut there are limb extremity dysfunctions. The lessons are that we should be alert to those comatoseemergency patients with hyperglycemia, which could make them lethal in the short term. So weshould need to fight against the time to heal them, not to delay the prime time of treatment forinspection. In addition, the peripheral neuropathy is a rare, possibly associated with multiple factors. Keywords: Diabetic ketoacidosis; Hypokalemia; Cardiac arrest; Rescue A 19 year-old man presented as an acute patient to the emergency department with coma anda 2-days history of oliguria, fatigue, being slow in reaction. The blood sugar test showed: high.And we noted that the patient was overweight. His parents stated that he had no past medicalhistory of note. On admission, his pulse was 107 times per minute, his blood pressure was 77 over44 mmHg and his temperature was 37.2oC. And both sides pupils were round and about 0.4 mm,direct and indire Continue reading >>

Hypokalemia

Hypokalemia

Hypokalemia is when blood’s potassium levels are too low. Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. Your kidneys control your body’s potassium levels, allowing for excess potassium to leave the body through urine or sweat. Hypokalemia is also called: hypokalemic syndrome low potassium syndrome hypopotassemia syndrome Mild hypokalemia doesn’t cause symptoms. In some cases, low potassium levels can lead to arrhythmia, or abnormal heart rhythms, as well as severe muscle weakness. But these symptoms typically reverse after treatment. Learn what it means to have hypokalemia and how to treat this condition. Mild hypokalemia usually shows no signs or symptoms. In fact, symptoms generally don’t appear until your potassium levels are extremely low. A normal level of potassium is 3.6–5.2 millimoles per liter (mmol/L). Being aware of hypokalemia symptoms can help. Call your doctor if you are experiencing these symptoms: weakness fatigue constipation muscle cramping palpitations Levels below 3.6 are considered low, and anything below 2.5 mmol/L is life-threateningly low, according to the Mayo Clinic. At these levels, there may be signs and symptoms of: paralysis respiratory failure breakdown of muscle tissue ileus (lazy bowels) In more severe cases, abnormal rhythms may occur. This is most common in people who take digitalis medications (digoxin) or have irregular heart rhythm conditions such as: tachycardia (heartbeat too fast) bradycardia (heartbeat too slow) premature heartbeats Other symptoms include loss of appetite, nausea, and vomiting. You can lose too much potassium through urine, sweat, or bowel movements. Inadequate potassium intake and low magnesium levels can result in hypokalemia. M Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Abbas E. Kitabchi, PhD., MD., FACP, FACE Professor of Medicine & Molecular Sciences and Maston K. Callison Professor in the Division of Endocrinology, Diabetes & Metabolism UT Health Science Center, 920 Madison Ave., 300A, Memphis, TN 38163 Aidar R. Gosmanov, M.D., Ph.D., D.M.Sc. Assistant Professor of Medicine, Division of Endocrinology, Diabetes & Metabolism, The University of Tennessee Health Science Center, 920 Madison Avenue, Suite 300A, Memphis, TN 38163 Clinical Recognition Omission of insulin and infection are the two most common precipitants of DKA. Non-compliance may account for up to 44% of DKA presentations; while infection is less frequently observed in DKA patients. Acute medical illnesses involving the cardiovascular system (myocardial infarction, stroke, acute thrombosis) and gastrointestinal tract (bleeding, pancreatitis), diseases of endocrine axis (acromegaly, Cushing`s syndrome, hyperthyroidism) and impaired thermo-regulation or recent surgical procedures can contribute to the development of DKA by causing dehydration, increase in insulin counter-regulatory hormones, and worsening of peripheral insulin resistance. Medications such as diuretics, beta-blockers, corticosteroids, second-generation anti-psychotics, and/or anti-convulsants may affect carbohydrate metabolism and volume status and, therefore, could precipitateDKA. Other factors: psychological problems, eating disorders, insulin pump malfunction, and drug abuse. It is now recognized that new onset T2DM can manifest with DKA. These patients are obese, mostly African Americans or Hispanics and have undiagnosed hyperglycemia, impaired insulin secretion, and insulin action. A recent report suggests that cocaine abuse is an independent risk factor associated with DKA recurrence. Pathophysiology In Continue reading >>

Successful Use Of Renal Replacement Therapy For Refractory Hypokalemia In A Diabetic Ketoacidosis Patient

Successful Use Of Renal Replacement Therapy For Refractory Hypokalemia In A Diabetic Ketoacidosis Patient

Volume 2019 |Article ID 6130694 | 3 pages | Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient 1Department of Medicine, Saint Josephs University Medical Center, 703 Main St, Paterson, NJ, USA 2New York Medical College, Valhalla, NY, USA A 39-year-old African-American female presented to the emergency department with a seven-day history of right upper quadrant abdominal pain accompanied by nausea, vomiting, and diarrhea. She was noted to be alert and following commands, but tachypneic with Kussmaul respirations; and initial laboratory testing supported a diagnosis of diabetic ketoacidosis (DKA) and hypokalemia. To avoid hypokalemia-induced arrhythmias, insulin administration was withheld until a serum potassium (K) level of 3.3 mEq/L could be achieved. Efforts to increase the patients potassium level via intravenous repletion were ineffectual; hence, an attempt was made at more aggressive potassium repletion via hemodialysis using a 4 mEq/L K dialysate bath. The patient was started on Aldactone and continuous veno-venous hemodialysis (CVVH) with ongoing low-dose insulin infusion. This regimen was continued over 24 h resulting in normalization of the patients potassium levels, resolution of acidosis, and improvement in mental status. Upon resolution of her acidemia, the patient was transitioned from insulin infusion to treatment with a subcutaneous insulin aspart and insulin detemir, and did not experience further hypokalemia. Considering our success, we propose CVVH as a tool for potassium repletion when aggressive intravenous (IV) repletion has failed. Hospitalizations for diabetic ketoacidosis (DKA) have soared in incidence over the recent years, increasing 54.9% from 19.5 to 30.2 hospitalizations per 1,000 people Continue reading >>

[full Text] Correlation Of Acidosis-adjusted Potassium Level And Cardiovascular Ou | Dmso

[full Text] Correlation Of Acidosis-adjusted Potassium Level And Cardiovascular Ou | Dmso

The protocol was registered with PROSPERO (Registration Number: CRD42018098772). An article was included if it met the following criteria: 1) the study reported the prevalence of DKA in adult diabetic patients and assessed admission potassium level and pH; 2) the study qualitatively observed cardiovascular outcomes in DKA patients; 3) the design of the study was a cross-sectional or cohort, or randomized controlled trial. Studies were excluded if 1) it was a case-control, case report, conference proceeding, systematic review, letter to editor, an opinion, or research brief; 2) published in languages other than English; 3) reported DKA secondary to pregnancy or among pediatrics, or 4) studies evaluating therapeutic intervention which includes DKA secondary to sodium-glucose co-transporter 2 inhibitor. Level of serum potassium, and pH-adjusted corrected level of potassium at the time of admission. Cardiovascular outcomes in relation to potassium in DKA episode Specifically, the CV outcomes were noted in relation to the level of potassium at the time of occurrence of CV event and included ECG, report of fibrillation, tachycardia or bradycardia, central venous pressure, cardiac arrest, myocardial infarction, and troponin. Moreover, reports of CV outcomes or signs and symptoms were recorded if the CV outcome was reported as the reason for fatality. It was further noted if any relationship was given by the authors between hypokalemia and the reason for such CV outcome. All references retrieved were initially grouped under the respective search engine. Duplicates were removed, and titles were screened for eligibility. After removal of irrelevant studies, regrouping was done according to the nature of the study, ie, case series, clinical trial, guideline, etc. Relevant demogra Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>

What Is Hypokalemia?

What Is Hypokalemia?

If you have hypokalemia, that means you have low levels of potassium in your blood. Potassium is a mineral your body needs to work normally. It helps muscles to move, cells to get the nutrients they need, and nerves to send their signals. It’s especially important for cells in your heart. It also helps keep your blood pressure from getting too high. Causes There are many different reasons you could have low potassium levels. It may be because too much potassium is leaving through your digestive tract. It’s usually a symptom of another problem. Most commonly, you get hypokalemia when: You vomit a lot Your kidneys or adrenal glands don’t work well You take medication that makes you pee (water pills or diuretics) It’s possible, but rare, to get hypokalemia from having too little potassium in your diet. Other things sometimes cause it, too, like: Drinking too much alcohol Diabetic ketoacidosis (high levels of acids called ketones in your blood) Laxatives taken over a long period of time Certain types of tobacco Low magnesium Several syndromes can be associated with low potassium, such as: Gitelman syndrome Liddle syndrome Bartter syndrome Fanconi syndrome Women tend to get hypokalemia more often than men. Symptoms If your problem is temporary, or you’re only slightly hypokalemic, you might not feel any symptoms. Once your potassium levels fall below a certain level, you might experience: Hypokalemia can affect your kidneys. You may have to go to the bathroom more often. You may also feel thirsty. You may notice muscle problems during exercise. In severe cases, muscle weakness can lead to paralysis and possibly respiratory failure. Continue reading >>

Hyperglycemia & Low Potassium

Hyperglycemia & Low Potassium

Hyperglycemia, or high blood sugar, is a potentially serious health condition affecting individuals with diabetes. Hyperglycemia can trigger a severe depletion of potassium, a mineral that serves many critical functions in the human body. Carefully follow medical advice for diabetes management including dietary restrictions and medication to minimize the impact of hyperglycemia and the potential for total body potassium depletion. Video of the Day Potassium is a necessary dietary mineral which must be consumed daily, as it is easily soluble and flushes out in the urine, according to Dr. Elson M. Haas of Periodic Paralysis International. Potassium is the primary mineral found inside of human body cells, while sodium is the primary mineral found outside the body cells. Potassium and sodium must be maintained in careful balance. Potassium is plentiful in fresh fruits, vegetables and whole grains, but is easily lost in the cooking process. Consuming an excess of sodium in relation to potassium can lead to high blood pressure and other negative health consequences. Hyperglycemia, or high serum glucose levels, happens occasionally in nearly all diabetics but must be carefully monitored and corrected as it may lead to serious complications like diabetic ketoacidosis and diabetic coma, according to the MayoClinic.com. In addition to high blood glucose levels, symptoms of hyperglycemia include frequent urination and increased thirst. Hyperglycemia results from too little insulin or inefficient insulin use and may also occur due to stress or illness, according to the American Diabetes Association. Low Potassium Effects Potassium deficiency can be caused by dietary insufficiency, chronic illness, heavy sweating, or the prolonged use of diuretics or laxatives, according to Dr. Elso Continue reading >>

Hyperkalemia (high Blood Potassium)

Hyperkalemia (high Blood Potassium)

How does hyperkalemia affect the body? Potassium is critical for the normal functioning of the muscles, heart, and nerves. It plays an important role in controlling activity of smooth muscle (such as the muscle found in the digestive tract) and skeletal muscle (muscles of the extremities and torso), as well as the muscles of the heart. It is also important for normal transmission of electrical signals throughout the nervous system within the body. Normal blood levels of potassium are critical for maintaining normal heart electrical rhythm. Both low blood potassium levels (hypokalemia) and high blood potassium levels (hyperkalemia) can lead to abnormal heart rhythms. The most important clinical effect of hyperkalemia is related to electrical rhythm of the heart. While mild hyperkalemia probably has a limited effect on the heart, moderate hyperkalemia can produce EKG changes (EKG is a reading of theelectrical activity of the heart muscles), and severe hyperkalemia can cause suppression of electrical activity of the heart and can cause the heart to stop beating. Another important effect of hyperkalemia is interference with functioning of the skeletal muscles. Hyperkalemic periodic paralysis is a rare inherited disorder in which patients can develop sudden onset of hyperkalemia which in turn causes muscle paralysis. The reason for the muscle paralysis is not clearly understood, but it is probably due to hyperkalemia suppressing the electrical activity of the muscle. Common electrolytes that are measured by doctors with blood testing include sodium, potassium, chloride, and bicarbonate. The functions and normal range values for these electrolytes are described below. Hypokalemia, or decreased potassium, can arise due to kidney diseases; excessive losses due to heavy sweating Continue reading >>

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