Hypokalemia during treatment of diabetic ketoacidosis: clinical evidence for an aldosterone-like action of insulin.

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.

• Authors: Ana Paula de Carvalho Panzeri Carlotti, Cecilia St George-Hyslop, Desmond Bohn, Mitchell Lewis Halperin
• Journal: The Journal of pediatrics (J Pediatr) Vol. 163 Issue 1 Pg. 207-12.e1 (Jul 2013) ISSN: 1097-6833 [Electronic] United States
• PMID: 23410602 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Mosby, Inc. All rights reserved.

Chemical References

• Insulin
• Aldosterone

Topics

• Adolescent
• Aldosterone (pharmacology)
• Child
• Child, Preschool
• Diabetic Ketoacidosis (drug therapy)
• Female
• Humans
• Hypokalemia (etiology)
• Infant
• Insulin (adverse effects, pharmacology, therapeutic use)
• Male
• Prospective Studies