Mapping the role of pH‐adjusted potassium in diabetic ketoacidosis: Hypokalemia and the patient outcomes

Abstract

Hypokalemia is a frequently observed complication during the treatment of diabetic ketoacidosis (DKA). Its incidence ranges anywhere between 4% and 60% where it adversely affects patient outcomes and may also add to the total cost of DKA treatment and extended hospitalisation. 1,2 Mainly, insulin is responsible to maintain the intracellular-(ICF) and extracellular-fluid (ECF) balance of potassium. 3 In addition, catecholamines and aldosterone also regulate serum potassium (S K ) level. 3,4 Pathophysiology of DKA causes an abrupt change in the concentration of these hormones and total body water (TBW). However, the resultant effect is observed partially at the time of admission when patients are either hyperkalemic or eukalemic. 5,6 With the commencement of DKA treatment, expansion of contracted hemoconcentration and insulin-mediated ECF to ICF movement of potassium causes a sudden drop in S K . 7,8 Though such

Covid-19 infection in children and adolescents and its association with type 1 diabetes mellitus (T1d) presentation and management

“…Refractory hypokalemia in patients with COVID-19 infection and DKA can be explained by the following mechanism: COVID-19 infection is associated with low expression of ACE2 receptors, leading to reduced degradation of angiotensin II and increased aldosterone production, which is accompanied by potassium loss in the urine. Urine potassium loss worsens the hypokalemia, that usually follows DKA and is due to the movement of potassium cations during metabolic acidosis from the extracellular to the intracellular space due to insulin administration [ 76 ]. This, in association with potassium urine loss, could result in severe hypokalemia during COVID-19 infection and the need for high doses of potassium chloride for its management [ 74 ].…”