launchpad
Forum Newbie
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can anyone plz tell me what happens to the Na and K levels in DKA.kaplan says there is hypernatremia and hypokalemia.
but should'nt there be hypo of both coz of the osmotic diuresis!
plz help me with this guys!!!!!!!
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| frontal
Forum Guru
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launchpad:
There is no hypernatremia in DKA. There is electrolyte loss in DKA primariy due to hyperglycemia causing osmotic diuresis, so the patient is depleted of both Na and K, but the serum levels of potassium maybe normal or even elevated. This is because of a disproportionate loss of water (osmotic diuresis) and because of acidosis, which forces the hydrogen ions into cells in exchange for K ions. Remember: a patient with DKA is potassium depleted, even if serum potassium values are on the higher side at presentation. Renal loss continues and as treatment with insulin is started, a fall in serum potassium is likely to be observed because insulin pushes the K ions back into the cells. Electrolye monitoring is necessary while treating the patient, so that insulin dose can be adjusted and fluids given appropriately.
Total body stores of Na (as well as of other electrolyes) are reduced, but are not accurately reflected in their levels in serum because of dehydration.
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| frontal
Forum Guru
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A normal serum sodium level in DKA would indicate profound dehydration.
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| launchpad
Forum Newbie
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hi frontal ,
yeah thats true and also exacly why i was confused when in kaplan material internal medicine in nephrology section DKA was given under the etiology of hypernatremia.
is it due to the dehydration which overwhelms the Na loss and therefore gives hypernatremia?
any ways thanks a lot for the clarification.
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| frontal
Forum Guru
Topics: 53
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You've got it right! Extreme dehydration can result in normal serum Na levels in DKA. That's about as far as Harrison's goes. There is no mention of hypernatremia. It's mostly hypo and less often, normal, so I guess it's best to take concept of hypernatremia in DKA off your mind. But whatever the case, the body is always depleted of Na and other electrolytes.
Good luck buddy.
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