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Why Does Ketoacidosis Cause Hypokalemia

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What is HYPOKALEMIA? What does HYPOKALEMIA mean? HYPOKALEMIA meaning - HYPOKALEMIA pronunciation - HYPOKALEMIA definition - HYPOKALEMIA explanation - How to pronounce HYPOKALEMIA? Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Hypokalemia, also spelled hypokalaemia, is a low level of potassium (K+) in the blood serum. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels below 3.5 mmol/L defined as hypokalemia. Mildly low levels do not typically cause symptoms. Symptoms may include feeling tired, leg cramps, weakness, and constipation. It increases the risk of an abnormal heart rhythm such as bradycardia and cardiac arrest. Causes of hypokalemia include diarrhea, medications like furosemide and steroids, dialysis, diabetes insipidus, hyperaldosteronism, hypomagnesemia, and not enough intake in the diet. It is classified as severe when levels are less than 2.5 mmol/L. Low levels can also be detected on an electrocardiogram (ECG). Hyperkalemia refers to a high level of potassium in the blood serum. The speed at which potassium should be replaced depends on whether or not there are symptoms or ECG changes

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 f Continue reading >>

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  1. nurseprnRN

    The hypokalemia comes when the patient gets treated with insulin, driving the glucose and K+ into the cells. The kidneys can't (and won't) move so much out through urine with the excess glucose to make for hypokalemia.

  2. Esme12

    There can be a brief period of hypoglycemia in the early stages of an elevated blood sugar (polyuria)....but by the time "ketoacidosis" sets in the Serum potassium is elevated but the cellular potassium is depleted (all that shifting that goes on)
    Diabetic ketoacidosis

  3. April2152

    So pretty much what we would observe clinically is hyperkalemia because the osmotic duiresis does not move serum potassium significantly?

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Quick and Easy Overview of Potassium Hyperkalemia Hypokalemia ( Please Read Description) This is a quick and easy overview of learning potassium. Too much potassium is hyperkalemia and low potassium is hypokalemia. If you like this video please remember to "like", "comment" and "subscribe". Thank you for watching

Hypokalemia And Hyperkalemia

Sort Adrenal causes of hyperkalemia? Adrenal gland is important in secreting hormones such as cortisol and aldosterone. Aldosterone causes the kidneys to retain sodium and fluid while excreting potassium in the urine. Therefore diseases of the adrenal gland, such as Addison's disease, that lead to decreased aldosterone secretion can decrease kidney excretion of potassium, resulting in body retention of potassium, and hence hyperkalemia. How trauma leads to hyperkalemia Another cause of hyperkalemia is tissue destruction, dying cells release potassium into the blood circulation. Examples of tissue destruction causing hyperkalemia include: trauma, burns, surgery, hemolysis (disintegration of red blood cells), massive lysis of tumor cells, and rhabdomyolysis (a condition involving destruction of muscle cells that is sometimes associated with muscle injury, alcoholism, or drug abuse). What is role of potassium binders (Sodium polystyrene suffocate: SPS) SPS exchanges sodium for potassium and binds it in the gut, primarily in the large intestine, decreasing the total body potassium level by approximately 0.5-1 mEq/L. Multiple doses are usually necessary. Onset of action ranges from 2 to Continue reading >>

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  1. Seetal

    Can someone pls explain HOW does hypokalemia prolong paralytic ileus? does it by any chance cause atony of the intestine? if yes, how does it work?
    My internet is slow today n i cant find the answer that im looking for.

  2. jinal222

    Yes! hypokalemia causes atony of intestinal muscles. this is because k has an imp role in nerve signal transmission and also for excitability of all muscle cell. therefore if paralytic ileus is already there then, decrease k level will prolong the recovery of paralytic ileus.
    this what i have read for step 1 some where in acid base balance or initial chapters.
    Please confirm this and correct if i am wrong.
    best luck for studies.

  3. 1TA2B

    Paralytic ileus, also called pseudo-obstruction is a condition in which the bowel doesn't work correctly but there is no structural problem. Causes of paralytic ileus may include:
    Chemical, electrolyte, or mineral disturbances (such as decreased potassium levels)
    Complications of intra-abdominal surgery
    Decreased blood supply to the abdominal area (mesenteric artery ischemia)
    Injury to the abdominal blood supply
    Intra-abdominal infection
    Kidney or lung disease
    Use of certain medications, especially narcotics (
    http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001306/)

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Clinical Update 2013 Speakers' Presentations - 2013 Canadian Diabetes Association Clinical Practice Guidelines: The Essentials - Alice Cheng

Practice Essentials

Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Moderate hypokalemia is a serum level of 2.5-3.0 mEq/L, and severe hypokalemia is a level of less than 2.5 mEq/L. Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or a shift of potassium from the extracellular to the intracellular space. Increased excretion is the most common mechanism. Poor intake or an intracellular shift by itself is a distinctly uncommon cause, but several causes often are present simultaneously. (See Etiology.) Gitelman syndrome is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis and low blood pressure. See the image below. Signs and symptoms Patients are often asymptomatic, particularly those with mild hypokalemia. Symptoms that are present are often from the underlying cause of the hypokalemia rather than the hypokalemia itself. The symptoms of hypokalemia are nonspecific and predominantly are related to muscular or cardiac function. Complaints may include the following: Weakness and fatigue (most commo 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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