title: Hypokalaemia and refractory asystole complicating diabetic ketoacidosis, lessons for prevention.
abstract: We report a unique case of diabetic ketoacidosis in which a relatively low potassium level on admission was associated with consequent life-threatening and refractory arrhythmia secondary to inappropriate use of intravenous insulin and bicarbonate therapy. The latter was reversed by rapid bolus potassium injection. Although we do not advocate this approach in every case, we emphasise that a bolus injection of potassium may be life saving in such cases. The lessons from this case have led to multidisciplinary meetings and modification of the institute's diabetic ketoacidosis clinical pathway.
authors.affiliation: Department of Internal Medicine, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. dr-salman@hotmail.com
authors.forename: Salman
authors.initials: S
authors.lastname: Abdulaziz
authors.forename: Ousama
authors.initials: O
authors.lastname: Dabbagh
authors.forename: Mohamed Ousama
authors.initials: MO
authors.lastname: Al Daker
authors.forename: Imad
authors.initials: I
authors.lastname: Hassan
mesh_terms: D000328:Adult; D016883:Diabetic Ketoacidosis / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007008:Hypokalemia / Q000150:complications* / Q000188:drug therapy; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D011189:Potassium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D017693:Sodium Bicarbonate / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D011189:Potassium Chloride; D017693:Sodium Bicarbonate