title: Prevalence of hypokalemia in ED patients with diabetic ketoacidosis.
abstract: OBJECTIVE
  Although patients with diabetic ketoacidosis (DKA) are expected to have total body potassium depletion, measured levels may be normal or elevated due to extracellular shifts of potassium secondary to acidosis. Because insulin therapy decreases serum potassium levels, which creates potential to precipitate a fatal cardiac arrhythmia in a patient with hypokalemia, the American Diabetes Association (ADA) recommends obtaining a serum potassium level before giving insulin. Although the ADA guidelines are clear, the evidence on which they are based is largely anecdotal. The purpose of this study was to estimate the prevalence of hypokalemia in patients with DKA before initiation of fluid resuscitation and insulin therapy.
  
  
  METHODS
  This is a prospective cross-sectional descriptive study of patients with a capillary blood glucose level of 250 mg/dL or higher (at risk for DKA) seen in an urban county emergency department over a 1-year period. Those who consented provided basic demographic information and had a venous blood gas and chemistry panel drawn. Diabetic ketoacidosis and hypokalemia were defined using ADA recommendations.
  
  
  RESULTS
  The mean age in our sample was 40.2 years, and 81% of patients were Hispanic. Of 503 analyzable patients with hyperglycemia, 54 (10.7%) met all criteria for DKA. Of patients with DKA, 3 (5.6%) of 54 (95% confidence interval, 1.2%-15.4%) had hypokalemia. Two of these patients had values of 3.0 mmol/L, and 1 had a value of 2.8 mmol/L.
  
  
  CONCLUSIONS
  Hypokalemia was observed in 5.6% of patients with DKA. These findings support the ADA recommendation to obtain a serum potassium before initiating intravenous insulin therapy in a patient with DKA.
authors.affiliation: Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, USA. sanjay.arora@usc.edu
authors.forename: Sanjay
authors.initials: S
authors.lastname: Arora
authors.forename: Daniel
authors.initials: D
authors.lastname: Cheng
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wyler
authors.forename: Michael
authors.initials: M
authors.lastname: Menchine
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000150:complications* / Q000628:therapy; D004636:Emergency Service, Hospital; D005440:Fluid Therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007008:Hypokalemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D007328:Insulin / Q000627:therapeutic use; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D011188:Potassium