bose
Forum Senior
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Which of the following electrolyte abnormalities is most likely seen in DKA?
a) Hyperkalemia and Hyperphosphatemia
b) Hyperkalemia and Hypophosphatemia
c) Hypokalemia and Hyperphosphatemia
d) Hypokalemia and Hypophosphatemia
e) Hypercalcemia and Hypophosphatemia
f) Hypocalcemia and Hypophosphatemia
Can you also explain the reason? This Q is from NBME.
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| dev
Forum Guru
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i thinkits B.but not sure.
how did u get the questions form nbme?didu note them down
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| bose
Forum Senior
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Answer is Hypokalemia + Hypophosphatemia
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| bobby
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| | 05/10/05 - 12:29 PM
3 of 3 forum leaders found this post helpful
| #4 |
correct ans. D. Hypokalemia and Hypophosphatemia
hyperglycemia and hyperketonemia that result from DKA will spill over into the urine causing an osmotic diuresis to occur.
This profound diuresis causes significant electrolyte losses particularly potassium, phosphate and magnesium.
Although the patient is losing many electrolytes, their initial levels may be normal or elevated due to cell death (from dehydration) within the body and release of intracellular electrolytes.
[acidosis, which develops due to the increased ketones in the serum, promotes potassium moving out of cells (hyperkaliemia) to buffer the pH change. (hydrogen moves into the cells, potassium moves out)]
Hypokalemia is usually a complication that is precipitated by failing to rapidly address the total body potassium deficit brought out by rehydration and insulin treatment, which not only reduce acidosis but directly facilitate potassium reentry into the cell.
Phosphate (and also magnesium) replacements are not typically needed, since levels correct when patient resumes eating.
hope this helps.
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| bose
Forum Senior
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| | 05/10/05 - 06:02 PM
0 of 1 forum leaders found this post helpful
| #5 |
Awesome explanation! Good job Bobby.
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| iota
Forum Newbie
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| | 05/24/05 - 12:03 PM
1 of 1 forum leaders found this post helpful
| #6 |
any one please clear the doubt:
total body K and phosphate are low due to osmotic diuresis in DKA.
BUT DKA pt presents with hyperkalemia and hyperphostemia because of lack of insulin and ketoacidosis . it is only after when treatment is started then we start seeing hypokalemia and hypophosphatemia.
so ans is A or D...?? anyone please explain this...
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| piter
Forum Elite
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agree with iota
in acute DKA (before treatment) there are Hyperkalemia and Hyperphosphatemia!
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| nightflight1945
Forum Guru
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The correct answer is B.
Hyperkalemia is due to shift of potasium out of cell along with water to replace extracellular water deficit(although the total body potasium content is usually less than normal)
for phosphate I don't know the exact reason but it is written in Harrison's without anty comment on its reason
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| REDHEAD
Forum Junior
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It is the acidosis that drives the K out of the cells; as soon as you give insulin and corect the acidosis the hyperK may turn into hypoK.
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| Vai
Forum Elite
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the term kalemia or phosphatemia(-emia) refer to the blood value of "k" and no to the total body "k" thus kalemia will be elevated because of acidosis in DKA in spite of lower level of total body "k" from renal wasting
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