Potassium

• Potassium is mainly an intracellular ion, and there is always massive depletion of total body potassium in diabetic ketoaci-dosis, although initial plasma levels may be low, normal or even high. Circulating levels will fall once insulin therapy is commenced.

• Potassium replacement should therefore be started immediately unless anuria is suspected or there are peaked T waves on the electrocardiogram. The infusion should be altered according to subsequent plasma electrolyte results to maintain plasma potassium concentration within the normal range.

• Add 20 mmol potassium chloride (KCl) to every 500 mL bag of fluid if normokalaemia.

• A cardiac monitor should be observed frequently for T wave changes.

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