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  #1  
Old 11-29-2009
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Pancreas Potassium Insulin Relationship

What does insulin do to potassium and what does potassium do to insulin secretion is a concept that is frequently tested in USMLE Step 1.
Let's summarize here and I'd be happy if you enrich this thread with your valuable posts.

  • Insulin causes Potassium to shift into the cells thereby decreasing the extracellular K level. That's why insulin is used in the treatment of hyperkalemia.
  • Level of Potassium in the serum also affects insulin secretion from the pancreas. Because the beta cells have an ATP dependent K channel which is when closed leads to retained K inside the beta cell which favors depolarization thereby enhancing Calcium mediated release of secretory granules. Therefore, in hyperkalemia more K will enter the beta cell and insulin secretion will increase and conversely in hypokalemia the K ions are more likely to leave the beta cell and so insulin secretion will decrease.
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Old 11-29-2009
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thanks..it will help many
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Old 11-30-2009
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Thanx for the useful post. I was aware of insulin effect on K but not the reverse.

In DKA (insulin deficiency) K is shifted extracellularly but is also lost in urine, so the patient's intracellular K is much depleted than the serum test.

I also find it very useful for the USMLE and real life to know other causes of K intracellular shift (not necessarily loss), these include:

1- B2 effect: That's why you should check K level after you give multiple doses of bronchodilator to patient in severe asthmatic attack. It's also used in rapid adjunctive treatment of hyperkalemia. B blockers cause hyperkalemia.
2-Alkalosis: so most of the time you see alkalosis you see hypokalemia in association, exceptions include loss of intestinal fluid (diarrhea, villous adenoma) and RTA types 1 and 2. Alkalosis also increases K excretion. Acidosis cause extracellular K shift.
3-A very rare disorder that is really not worth mentioning is hypokalemic periodic paralysis.
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i could not find much of all this in kaplan, sorry but please if u could tell the source then it would be great. thanks
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Old 11-30-2009
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Quote:
Originally Posted by syedaanaqvi View Post
i could not find much of all this in kaplan, sorry but please if u could tell the source then it would be great. thanks
Here's a quote from the Merck Manual
http://www.merck.com/mmpe/sec12/ch15...156-ch156f-785
Here's an article from SpringerLink
http://www.springerlink.com/content/qq127wxj4cnwq6cd/
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Cool

my source is Davidson's medicine 2006 edition which I think is a very useful tool, not to prepare for the boards, but I would definitely choose to study from it in med school.

The info are mostly in hypokalemia section
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Old 07-08-2010
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Quote:
Originally Posted by DrSeddik View Post
Thanx for the useful post. I was aware of insulin effect on K but not the reverse.

In DKA (insulin deficiency) K is shifted extracellularly but is also lost in urine, so the patient's intracellular K is much depleted than the serum test.

I also find it very useful for the USMLE and real life to know other causes of K intracellular shift (not necessarily loss), these include:

1- B2 effect: That's why you should check K level after you give multiple doses of bronchodilator to patient in severe asthmatic attack. It's also used in rapid adjunctive treatment of hyperkalemia. B blockers cause hyperkalemia.
2-Alkalosis: so most of the time you see alkalosis you see hypokalemia in association, exceptions include loss of intestinal fluid (diarrhea, villous adenoma) and RTA types 1 and 2. Alkalosis also increases K excretion. Acidosis cause extracellular K shift.
3-A very rare disorder that is really not worth mentioning is hypokalemic periodic paralysis.
And in DKA , shifted K is shifted again into the cell with glucose when we give insulin.So , extracellular K is more depleted. Sorry, if any mistake, as it's my first comment.
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