DKA and Potassium - page 2

by apocatastasis

8,408 Views | 11 Comments

So I had a situation the other day when I came on shift and took a patient from an RN, and she goes, "This patient has DKA, started the insulin drip, K was 6.3 so we gave Kayexalate..." I stopped her and was like, Kayexalate... Read More


  1. 1
    Hi,
    In my ER we have a protocol for DKA that says we bolus 2L NS and start insulin drip. We check blood sugars q2 hours and titrate insulin gtt accordingly. After the 2L NS bolus, we start 1/2 NS with 20 of K no matter what the K is since they will drop as they rehydrate and normalize their insulin. When they get sent to a room (whether it's ICU or a tele unit) they automatically get placed on electrolyte replacement protocols. We would NEVER give kayexelate for a high K on a DKA patient!

    Yikes, I shudder to think!
    GleeGum likes this.
  2. 1
    Many of our DKA's are on hourly litres of N/saline, so their K+ dilutes down, as well as the intracellular insulin-driven shift. Until the BSL is under 15mmol/L (270mg/DL) we replace K+ at a rate of 20mmol/hr if lab K+ is under 3.5, 10mmol/l if 3.5-5. and 5mmol/L if K+ is over 5; I've never had a patient in DKA with a glucose above 15 who had K+ replacement withheld, particularly if they're still acidotic.

    Our DKA patients are nursed on the endocrine ward (mine!) unless their pH is under 7.0 in ED, in which case they spend some time in ICU.
    Skeletor likes this.


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