Hypokalemia during Treatment of Diabetic Ketoacidosis: Clinical Evidence for an Aldosterone-Like Action of Insulin - 22/06/13
Abstract |
Objectives |
To investigate whether the development of hypokalemia in patients with diabetic ketoacidosis (DKA) treated in the pediatric critical care unit (PCCU) could be caused by increased potassium (K+) excretion and its association with insulin treatment.
Study design |
In this prospective observational study of patients with DKA admitted to the PCCU, blood and timed urine samples were collected for measurement of sodium (Na+), K+, and creatinine concentrations and for calculations of Na+ and K+ balances. K+ excretion rate was expressed as urine K+-to-creatinine ratio and fractional excretion of K+.
Results |
Of 31 patients, 25 (81%) developed hypokalemia (plasma K+ concentration <3.5 mmol/L) in the PCCU at a median time of 24 hours after therapy began. At nadir plasma K+ concentration, urine K+-to-creatinine ratio and fractional excretion of K+ were greater in patients who developed hypokalemia compared with those without hypokalemia (19.8 vs 6.7, P = .04; and 31.3% vs 9.4%, P = .004, respectively). Patients in the hypokalemia group received a continuous infusion of intravenous insulin for a longer time (36.5 vs 20 hours, P = .015) and greater amount of Na+ (19.4 vs 12.8 mmol/kg, P = .02). At peak kaliuresis, insulin dose was higher in the hypokalemia group (median 0.07, range 0-0.24 vs median 0.025, range 0-0.05 IU/kg; P = .01), and there was a significant correlation between K+ and Na+ excretion (r = 0.67, P < .0001).
Conclusions |
Hypokalemia was a delayed complication of DKA treatment in the PCCU, associated with high K+ and Na+ excretion rates and a prolonged infusion of high doses of insulin.
Le texte complet de cet article est disponible en PDF.Keyword : ATPase, DKA, ENaC, IV, K+, Na+, PCCU, PGlucose, PK, ROMK, UCreatinine, UK, UNa, UNa+K
Plan
Supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (1309/06-4) and Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. The authors declare no conflicts of interest. |
Vol 163 - N° 1
P. 207 - juillet 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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