Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which electrolyte level can be life-threatening if not corrected during diabetic ketoacidosis (DKA)?

1. Potassium

2. Phosphate

3. Sodium bicarbonate

4. Sodium

The correct answer is: Potassium

In the context of diabetic ketoacidosis (DKA), potassium levels can become critically important and potentially life-threatening if not properly monitored and corrected. During DKA, there is a shift of potassium from the intracellular space to the extracellular space due to acidosis. As a result, patients may present with normal or even elevated serum potassium levels, but their total body potassium can be depleted due to urinary losses and other factors. This dual state can lead to significant hypokalemia once insulin treatment is initiated, as insulin drives potassium back into the cells. It is crucial to manage potassium levels carefully in patients with DKA because hypokalemia can result in serious complications such as cardiac arrhythmias, muscle weakness, and respiratory failure. In fact, potassium monitoring should accompany insulin administration, and potassium replacement may be necessary to prevent dangerous drops in serum levels. While phosphate, sodium bicarbonate, and sodium are also important electrolytes in the management of DKA, their imbalances are not typically as immediate and life-threatening as those seen with potassium. For instance, while phosphate levels can become low and may impact energy metabolism, they are not as acutely critical for cardiac function as potassium. Sodium bicarbonate may be considered in cases of severe acidosis, but its