In diabetic ketoacidosis, which electrolyte is most important to assess and correct before or during insulin therapy?

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Multiple Choice

In diabetic ketoacidosis, which electrolyte is most important to assess and correct before or during insulin therapy?

Explanation:
Potassium balance is the key issue when treating diabetic ketoacidosis. In DKA, total body potassium is depleted from urinary and GI losses and from a shift of potassium out of cells due to insulin deficiency and acidosis, so body stores are low even if the measured serum potassium is normal or high. When insulin therapy is started and acidosis begins to resolve, potassium is driven back into cells, causing a rapid drop in serum potassium. This can lead to life-threatening arrhythmias if not prevented. Therefore, potassium must be assessed and corrected before or during insulin therapy, with careful monitoring and appropriate supplementation to keep the serum potassium in a safe range (roughly 4–5 mEq/L).

Potassium balance is the key issue when treating diabetic ketoacidosis. In DKA, total body potassium is depleted from urinary and GI losses and from a shift of potassium out of cells due to insulin deficiency and acidosis, so body stores are low even if the measured serum potassium is normal or high. When insulin therapy is started and acidosis begins to resolve, potassium is driven back into cells, causing a rapid drop in serum potassium. This can lead to life-threatening arrhythmias if not prevented. Therefore, potassium must be assessed and corrected before or during insulin therapy, with careful monitoring and appropriate supplementation to keep the serum potassium in a safe range (roughly 4–5 mEq/L).

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