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  #1  
Old 07-27-2016
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Default Kaplan Question help

Hey guys,

I have uploaded a kaplan question here for diabetic ketoacidosis. The question asks about K+ management. In the stem of the question it says the K+ is 5.9 and the answer says that adding more K+ was the correct BUT from my previous readings from Uptodate it says K+ should be withheld if >5.3. I have attached a screenshot of that as well.

Can someone tell me if Kaplan is outdated or I am missing something.

Thanks
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Kaplan Question help-qq-20160727195833.jpg   Kaplan Question help-qq-20160727195839.jpg   Kaplan Question help-qq-20160727195902.jpg  
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Old 07-27-2016
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In DKA, the patient actually loses alot of potassium in urine along with Sodium and glucose, however the patient still has hyperkalemia as due to acidosis the H+ ions are exchanged for K+. So H+ diffuses into the cells and K+ takes its place in serum. Although it is true that the patient is hyperkalemic, however TOTAL POTASSIUM levels are decreased as tonnes of K+is lost in the urine. When treatment is begun and insulin is administered, insulin causes the K+ in serum to return back into the cells, thereby acutely decreasing serum K+ levels, causing hypokalemia. This is why K+ is administered later on so that the patient doesn't develop cardiac problems due to hyperkalemia.

Hope this helps.
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Old 07-27-2016
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Cardiac problems due to HYPOKALEMIA** sorry there was a typo in the last line
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Old 07-27-2016
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Quote:
Originally Posted by Ammad.khalid64 View Post
Cardiac problems due to HYPOKALEMIA** sorry there was a typo in the last line

Thanks Ammad for the reply, I understand the concept that you talked about but what I don't understand is the difference between what Uptodate says (which is to withhold K+ until below 5.3) and the answer of the question which says K+ should be given even at 5.9 which is beyond the recommendation from Uptodate.

Thanks
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