Case 1

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The initial potassium concentration was low (3.28 mmol/l) and the bolus of insulin resulted in an acute fall in potassium to 2.08 mmol/l. This was almost certainly the cause for the arrhythmia.

The immediate management of patients with diabetic ketoacidosis is fluid replacement. This in itself will result in substantial correction of the acidosis. Insulin boluses should not be given and even insulin infusion should not be started unless the potassium concentration is >3.5 mmol/l. If necessary replace potassium before starting an insulin infusion.

©Charles Gomersall, August, 2008 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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