Serum vs. Total Body Potassium in DKA

When pH drops, K+ is pumped out of the cell in exchange for H+ because the body is trying to neutralize the acid. This excess K+ then goes into the urine and is removed in copious amounts due to the osmotic diuresis caused by the high blood glucose levels. The α-intercalated cells in the renal tubule that normally recovers K+ are overwhelmed by the high amounts of both K+ & H+.

If the serum K+ is LOW, it will means the patient is very ill, act quickly!

When you treat them, if you give insulin before fixing the K+ it can cause a massive movement of K+ back into cell and result in hypokalemia. Please refer to your institution’s guidelines for when to treat K+ during DKA.


  1. Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2014;7:255-264. doi:10.2147/DMSO.S50516.
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Dr. C Humphreys

Internal Medicine

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