DKA and potassium

[April2152]

I searched through this site, my textbook and asked my teachers and I haven't found consistency or a concise answer. I understand that DKA effects potassium for a few reasons: during acidemia (sp?) hydrogen ions move into cells and potassium moves into the ECF, kidneys excrete glucose when levels are high excreting potassium with it and once insulin is administered potassium moves into cells. I also understand that potassium is withheld until levels are low or normal and that levels are monitored due to the potential risk of cardiac arrhythmias.

What I can't seem to get an answer to is which of these comes first. Hypokalemia or hyperkalemia? Does it depend on the pt? The severity of DKA? Any and all help is needed. It's on my first med surg test this week.

[nurseprnRN, BSN, RN]

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.

[Esme12, ASN, BSN, RN]

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

[April2152]

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

[suppaduppaCNA]

pH and K+ are inversely correlated. In DKA pH level drops therefore K+ level increases in ECF. Hyperkalemia will occur first. Then when the patient gets treated, the insulin drives back the K+ into the cells along with glucose causing Hypokalemia.

[April2152]

Right! I totally knew that but for some reason forgot to apply it to DKA.

Thanks everyone!