A client with diabetic ketoacidosis is receiving regular insulin via infusion pump. Which electrolyte disturbance should the nurse expect to see following the insulin infusion?

A client with diabetic ketoacidosis is receiving regular insulin via infusion pump. Which electrolyte disturbance should the nurse expect to see following the insulin infusion?

• A. Hypokalemia
• B. Hyperkalemia
• C. Hyponatremia
• D. Hypernatremia

Answer: (A)

Insulin therapy in diabetic ketoacidosis drives potassium from the bloodstream back into the cells. In DKA, despite often having normal or high serum potassium on presentation, total body potassium is depleted because of urinary losses from osmotic diuresis. As insulin is infused and acidosis resolves, potassium shifts intracellularly, causing a drop in serum potassium—that is, hypokalemia. This is why potassium levels must be monitored closely during treatment and replaced as needed to keep levels in a safe range. If potassium falls too low (commonly below about 3.3 mEq/L), insulin is held and potassium is given first; if potassium is in the 3.3–5.2 mEq/L range, insulin is continued with concurrent potassium replacement to maintain a target around 4–5 mEq/L. While hyponatremia or hypernatremia can occur due to osmotic shifts and fluid management, the most expected electrolyte change during insulin infusion is a decline in potassium leading to hypokalemia.

Insulin therapy in diabetic ketoacidosis drives potassium from the bloodstream back into the cells. In DKA, despite often having normal or high serum potassium on presentation, total body potassium is depleted because of urinary losses from osmotic diuresis. As insulin is infused and acidosis resolves, potassium shifts intracellularly, causing a drop in serum potassium—that is, hypokalemia. This is why potassium levels must be monitored closely during treatment and replaced as needed to keep levels in a safe range. If potassium falls too low (commonly below about 3.3 mEq/L), insulin is held and potassium is given first; if potassium is in the 3.3–5.2 mEq/L range, insulin is continued with concurrent potassium replacement to maintain a target around 4–5 mEq/L. While hyponatremia or hypernatremia can occur due to osmotic shifts and fluid management, the most expected electrolyte change during insulin infusion is a decline in potassium leading to hypokalemia.