Hyperkalemia in Diabetic Ketoacidosis

ABSTRACT

Patients with diabetic ketoacidosis tend to have somewhat elevated serum K⁺ concentrations despite decreased body K⁺ content. The hyperkalemia was previously attributed mainly to acidemia. However, recent studies have suggested that “organic acidemias” (such as that produced by infusing beta-hydroxybutyric acid) may not cause hyperkalemia. To learn which, if any, routinely measured biochemical indices might correlate with the finding of hyperkalemia in diabetic ketoacidosis, we analyzed the initial pre-treatment values in 131 episodes in 91 patients. Serum K⁺correlated independently and significantly (p < 0.001) with blood pH (r = −0.39), serum urea N (r = 0.38) and the anion gap (r = 0.41). The mean serum K⁺ among the men was 5.55 mmol/ 1, significantly higher than among the women, 5.09 mmol/1 (p < 0.005). Twelve of the 16 patients with serum K⁺ ≥ 6.5 mmol/1 were men, as were all eight patients with serum K⁺ ≥ 7.0 mmol/1. Those differences paralleled a significantly higher mean serum urea N concentration among the men (15.1 mmol/1) than the women (11.2 mmol/1, p < 0.01). The greater tendency to hyperkalemia among the men in this series may have been due partly to their greater renal dysfunction during the acute illness. However, other factors that were not assessed, such as cell K⁺ release associated with protein catabolism, and insulin deficiency per se, may also have affected serum K⁺ in these patients.