Podcast #290: The Biochemistry of DKA

Author: Dave Rosenberg, M.D.

Educational Pearls

• DKA commonly causes hyperkalemia, leading to peaked T-waves on ECG. However, DKA causes hypokalemia at the same time.
• In DKA, glucose cannot be taken into the cells. This signals the body to create and use acidic ketones for energy. This leads to acidosis. To compensate for increased acid, H ions are pumped into cells. To maintain electroneutrality, K is pumped out of the cell. At the kidney, K is lost in the urine.
• Overall, while serum K is high in DKA, total body K is low. The derangement in K can lead to life-threatening arrhythmias.
• Treatment for DKA can induce hypokalemia, as the K will shift back into the cells with insulin administration. Therefore, treatment for DKA needs to include K.

References:  http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetic-ketoacidosis-dka