Initial hypokalemia in diabetic ketoacidosis is an uncommon finding, implying severe total body potassium depletion in excess of that usually encountered. Five cases illustrate the therapeutic pitfalls and challenges presented by such a situation. Potassium replacement should commence early in treatment, after the presence of adequate urine output has been established. There are potential dangers of alkalinization in the face of hypokalemia. The role of magnesium metabolism in ketoacidosis may be significant.
Abramson E, Arky R. Diabetic Acidosis With Initial Hypokalemia: Therapeutic Implications. JAMA. 1966;196(5):401–403. doi:10.1001/jama.1966.03100180069021
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