Davis Shanlee M, Maddux Aline B, Alonso Guy T, Okada Carol R, Mourani Peter M, Maahs David M
Children's Hospital Colorado Pediatric Endocrinology, University of Colorado, Aurora, CO, USA.
Children's Hospital Colorado Intensive Care, University of Colorado Denver, Aurora, CO, USA.
Pediatr Diabetes. 2016 Feb;17(1):61-5. doi: 10.1111/pedi.12246. Epub 2014 Nov 27.
Hypokalemia is common during the treatment of diabetic ketoacidosis (DKA); however, severe hypokalemia at presentation prior to insulin treatment is exceedingly uncommon. A previously healthy 8-yr-old female presented with new onset type 1 diabetes mellitus, severe DKA (pH = 6.98), and profound hypokalemia (serum K = 1.3 mmol/L) accompanied by cardiac dysrhythmia. Insulin therapy was delayed for 9 h to allow replenishment of potassium to safe serum levels. Meticulous intensive care management resulted in complete recovery. This case highlights the importance of measuring serum potassium levels prior to initiating insulin therapy in DKA, judicious fluid and electrolyte management, as well as delaying and/or reducing insulin infusion rates in the setting of severe hypokalemia.
低钾血症在糖尿病酮症酸中毒（DKA）治疗期间很常见；然而，在胰岛素治疗前出现严重低钾血症极为罕见。一名先前健康的8岁女性，新发1型糖尿病，伴有严重DKA（pH = 6.98）及严重低钾血症（血清钾 = 1.3 mmol/L），并伴有心律失常。胰岛素治疗延迟了9小时，以便将钾补充至安全的血清水平。精心的重症监护管理使患者完全康复。该病例强调了在DKA患者开始胰岛素治疗前测量血清钾水平、谨慎进行液体和电解质管理以及在严重低钾血症情况下延迟和/或降低胰岛素输注速率的重要性。
