Question about DKA

Two different drugs, very important to regulate each on it's own.

When the body is in DKA there is a shift of potassium from the intracellular to the extracellular space in an exchange with hydrogen ions that accumulate extracellularly in acidosis. A large part of the shifted extracellular potassium is lost in urine because of osmotic diuresis.

I'm not a student...I'm arleady RN who is starting a new job and reviewing an "old" material:)

Reasons for loss of K+:

1) Respiratory alkalosis in response to metabolic acidosis drives K+ from extracellular fluid to an intracellular state

2) Polyuria results in a free water deficit dumping additional K+ in the urine

3) Insulin replacement (if they actually get it in time) further shifts K+ back towards an intracellular medium

Its multifactorial:

Potassium shift out of the cells in response to increased hydronium concentration (metabolic acidosis) with loss due to polyuria. It is very common to have extracellular shifts of potassium due to hydronium ion influx in the setting of acidosis.

Insulin therapy enhances intracellular shift along with a concomitant respiratory alkalosis.

Additional intracellular potassium shift with correction of the metabolic acidosis.

I always give insulin IVP unless a drip is ordered, obviously. It's also the only thing I push fast. I always dilute it because if not, there is absolutely nothing in the 3ml syringe.

Unfortunately, DKA physiology and management is ill understood by many nurses. I have even seen flight nurses take intubated DKA patients and note a low CO2, then "correct" the CO2 into the 35-45 range with mad ventilator skillz. Sort of sucks when you take away somebodies ability to compensate via the respiratory system. In addition, I have also seen nurses throw a fit when a DKA patient with a K+ of 5.8 has orders for potassium replacement while not appreciating that the patient is in fact potassium depleted. Therefore, a good topic to talk about.

Regular insulin IV mixed with potassium fluid in the same bag and given to the patient?

No. insulin bags should only contain insulin. K is usually included in whatever primary solution like NS with 20kcl for example.

That is why it's best to read up. Good links and your good 'ol physiology reference. Managing DKA is about leveling out the seesawing of fluids, potassium, insulin, glucose...