DKA: Electrolytes (Nursing)

00:01 So, let's talk about electrolytes in DKA. There are some really big changes in electrolytes particularly sodium, potassium, and phosphorus that happen when your blood sugar gets too high. So, let's start with the sodium. The sodium concentration may be either low or high and I know that doesn't seem quite as helpful, you know since it could be either, because there are 2 opposing effects of hyperglycemia. So, if you have low serum sodium, hyperglycemia causes water to move from inside the cells to outside the cells. And that can dilute out the serum sodium that you have in the bloodstream. So it's water that's moving from inside the cells to outside the cells. It gets into the bloodstream. So when you check that sodium, it's really just diluted out and so your sodium concentration looks low.

01:04 Hyperglycemia also causes water loss through that osmotic diuresis that we talked about. So you're losing water through the urine. If you lose enough water in the urine, then in that bloodstream, now it's more concentrated and so you might actually look like you have high sodium. So, either one of those things can happen with DKA. So for potassium, you're going to have an overall deficit in the body total potassium, but you initially are probably going to see levels that are somewhat normal. The somewhat normal levels are usually because during DKA, potassium moves from inside the cells to outside the cells. So, when you check your potassium levels in your serum, they're going to look somewhat normal.

01:54 Some potassium, however, during this time it's lost with the diuresis, it's lost with the vomiting so eventually as you start insulin therapy the insulin drives that potassium back into the cells and then in your blood vessels when you check your potassium levels now all of the sudden your potassium is going to look low. When we're thinking about phosphate, the phosphate is lost with diuresis and then the insulin therapy is going to shift that back into the cells. So, your serum phosphate also might be normal or high at presentation because that acidosis causes that phosphorus to move out of the cells. So, as you can see, the electrolytes get a little bit complicated and it really it depends on whether you started the insulin or not and this acidosis causes shifts of these electrolytes in and out of the cells, so you're going to see rising and decreasing levels throughout the course of the DKA that's why it's going to be really important and we'll talk about this a little bit later to keep really close track of what your electrolytes are doing.