Diabetic ketoacidosis: potassium abnormalities were common.

Clinical bottom line (level 4)

  1. 40% of patients with diabetic ketoacidosis had abnormal potassium levels.
Soler et al: Lancet 1972; 2: 665-667
Expires October 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospital, UK

25 patients (aged range 13 to 84 years, 80% female) severe diabetic ketoacidosis (pH <7.2, bicarbonate <10 mmol/l)
All patients had insulin bolus 100 units iv two hourly until glucose was <14 mmol/l. Patients were than swapped to subcutaneous route and repeated every 4-6 hours. Patients had regular potassium levels and continuous ECG monitoring.


Outcomes studied:
  • hyperkalaemia at admission
  • hypokalaemia at admission

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    hyperkalaemia at admission ? 7/25 28%
    (10% to 46%)
    hypokalaemia at admission ? 3/25 12%
    (0.0% to 25%)

    • Patients required on average 30-40 mmol of potassium per litre to keep serum potassium normal during rehydration.

    Citation

    1. Soler NG, Bennett MA, Dixon K, et al: Potassium balance during treatment of diabetic ketoacidosis. Lancet 1972; 2: 665-667
    Contributor: Chris Ball and Clare Wotton, July 2000
    Reviewer:

    Clinical Question.
    Patient DKA
    Intervention or Exposure prevalence
    Outcome abnormal potassium levels