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Profound hypokalemia associated with severe diabetic ketoacidosis
Author(s) -
Davis Shanlee M,
Maddux Aline B,
Alonso Guy T,
Okada Carol R,
Mourani Peter M,
Maahs David M
Publication year - 2016
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12246
Subject(s) - hypokalemia , medicine , diabetic ketoacidosis , insulin , diabetes mellitus , ketoacidosis , endocrinology , type 1 diabetes
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.