Considering Electrolyte Repletion
There are there metabolic elements that the EMT professional must be aware of in the diabetic emergency patient.
- Potassium -- Hypertonicity, insulin deficiency, and acidosis can cause a significant shift of K out of the intracellular space. This is important because diuresis has the capacity to cause significant urinary loss of K. In a diabetic emergency, the initial measured K could be normal or low when a severe K deficiency is present. If the patient has normal renal function, for the first 3 to 4 hours, add K to IVFs as follows: K < 3.5, give >40meq/L; K 3.5-4.0, give 40/L; K=4.0-4.5, give at 30/L; K=4.5-5.0, give at 20/L; K=5.0-5.3, give at 10/L.
- Magnesium -- Caution in renal failure, replace only if severe (<1.6) or in refractory hypokalemia.
- Phosphate -- There can be a total body phosphate deficit in both DKA and HHNS. Actual repletion of phosphate is rarely required unless it is severe. Severe repletion of phosphate is a reading of less than 1.0. It is important to follow with serum calcium because rapid phosphate repletion has the possibility to result in hypocalcemia. [4]
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