Question

Daryl is a 21 year old male with a history of Type 1 Diabetes. He is brought to the ER by his parents because he seems anxious and confused and has been experiencing nausea and vomiting. Upon exam he appears ill with dry mucous membranes and decreased skin turgor. His breath smells fruity, his pulse is rapid and weak, and his respirations are rapid and deep. His laboratory values include the following: Glucose 350 mg/dl, K+ 5.9 mEq/L, and his urine dipstick is positive for glucose and ketones. He is scheduled for an ABG.

What is the significance of Daryl’s potassium level and is this an expected finding? What change might you anticipate after treatment?

Answer 1

He is suffering from diabetic ketoacidosis.

In type 1 diabetes, the insulin secretion is either reduced severely or absent. Insulin is a hormone which is needed for intracellular shift of potassium. When insulin is absent, the intracellular shift doesn't takes place and potassium gets accumulated in the extracellular fluid which is measured in this test. So serum potassium value is either increased or normal. But this doesn't actually represents the total potassium content in the body which is usually severely reduced .

As soon as we start treatment with insulin, there will be a shift of extracellular potassium to intracellular compartment, thereby reducing the serum potassium levels. So serum potassium should be continuously monitored during the treatment and supplementation may be given when needed to prevent hypokalemic cardiac arrest.