title: Profound hypokalemia associated with severe diabetic ketoacidosis.
abstract: Hypokalemia is common during the treatment of diabetic ketoacidosis (DKA); however, severe hypokalemia at presentation prior to insulin treatment is exceedingly uncommon. A previously healthy 8-yr-old female presented with new onset type 1 diabetes mellitus, severe DKA (pH = 6.98), and profound hypokalemia (serum K = 1.3 mmol/L) accompanied by cardiac dysrhythmia. Insulin therapy was delayed for 9 h to allow replenishment of potassium to safe serum levels. Meticulous intensive care management resulted in complete recovery. This case highlights the importance of measuring serum potassium levels prior to initiating insulin therapy in DKA, judicious fluid and electrolyte management, as well as delaying and/or reducing insulin infusion rates in the setting of severe hypokalemia.
authors.affiliation: Children's Hospital Colorado Pediatric Endocrinology, University of Colorado, Aurora, CO, USA.
authors.forename: Shanlee M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: Children's Hospital Colorado Intensive Care, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Aline B
authors.initials: AB
authors.lastname: Maddux
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Guy T
authors.initials: GT
authors.lastname: Alonso
authors.affiliation: Children's Hospital Colorado Intensive Care, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Okada
authors.affiliation: Children's Hospital Colorado Intensive Care, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mourani
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000097:blood / Q000209:etiology*; D011188:Potassium / Q000097:blood; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D011188:Potassium
keywords: diabetic ketoacidosis; hypokalemia; insulin; low-dose insulin drip; pediatric