Clinical Analysis of Electrolyte Disorders in Patients with Diabetic Ketoacidosis

The changes in the electrolyte profiles in patients with diabetic ketoacidosis (DKA) have rarely been reported. This study reports the abnormalities in the electrolyte profile, such as serum potassium, sodium, chloride, calcium, magnesium, and phosphorus.

Forty individuals in each of the DKA, diabetic ketosis (DK), nonketotic diabetes mellitus, and healthy control groups were included in this study to evaluate their clinical indicators, such as blood glucose, glycated hemoglobin (HbA1c), renal function, electrolytes, and arterial blood gas concentrations.

Compared with the other three groups, patients in the DKA group had a longer course of diabetes; significantly higher levels of blood glucose, HbA1c, and serum creatinine (p < 0.05 or p < 0.001); lower estimated glomerular filtration rate (eGFR) (p < 0.001); and higher levels of serum potassium, sodium, phosphorus, magnesium, and effective osmotic pressure (p < 0.05). In the DKA patients, the incidences of hyperkalemia and hypokalemia were 32.5% (p < 0.05 or p < 0.001 vs. the other groups) and 7.5%, respectively. In the DKA patients, type 1 diabetes patients were younger and had higher blood glucose than type 2 patients (p < 0.05), but the electrolyte profiles were not significantly different. There were no significant differences in the serum electrolyte profile between mild to moderate DKA patients and severe DKA patients. Serum potassium was negatively correlated with eGFR (r = -0.378, p = 0.018). Regression analysis showed that eGFR was an important factor affecting serum potassium (β = -0.378, p = 0.018).

When DKA occurs in diabetes patients, the renal function deteriorates significantly because the electrolytes are generally elevated due to hemoconcentration. Hyperkalemia is the main manifestation, and it is necessary to prevent the decrease in serum potassium during the treatment.