Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient
A 39-year-old African-American female presented to the emergency department with a seven-day history of right upper quadrant abdominal pain accompanied by nausea, vomiting, and diarrhea. She was noted to be alert and following commands, but tachypneic with Kussmaul respirations; and initial laborato...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-01-01
|
| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2019/6130694 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849694582024962048 |
|---|---|
| author | Zainab Syed Thomas Kimball Mourad Ismail |
| author_facet | Zainab Syed Thomas Kimball Mourad Ismail |
| author_sort | Zainab Syed |
| collection | DOAJ |
| description | A 39-year-old African-American female presented to the emergency department with a seven-day history of right upper quadrant abdominal pain accompanied by nausea, vomiting, and diarrhea. She was noted to be alert and following commands, but tachypneic with Kussmaul respirations; and initial laboratory testing supported a diagnosis of diabetic ketoacidosis (DKA) and hypokalemia. To avoid hypokalemia-induced arrhythmias, insulin administration was withheld until a serum potassium (K) level of 3.3 mEq/L could be achieved. Efforts to increase the patient’s potassium level via intravenous repletion were ineffectual; hence, an attempt was made at more aggressive potassium repletion via hemodialysis using a 4 mEq/L K dialysate bath. The patient was started on Aldactone and continuous veno-venous hemodialysis (CVVH) with ongoing low-dose insulin infusion. This regimen was continued over 24 h resulting in normalization of the patient’s potassium levels, resolution of acidosis, and improvement in mental status. Upon resolution of her acidemia, the patient was transitioned from insulin infusion to treatment with a subcutaneous insulin aspart and insulin detemir, and did not experience further hypokalemia. Considering our success, we propose CVVH as a tool for potassium repletion when aggressive intravenous (IV) repletion has failed. |
| format | Article |
| id | doaj-art-fa09ee7a27e84c8aab24ef99f999208b |
| institution | DOAJ |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-fa09ee7a27e84c8aab24ef99f999208b2025-08-20T03:20:01ZengWileyCase Reports in Critical Care2090-64202090-64392019-01-01201910.1155/2019/61306946130694Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis PatientZainab Syed0Thomas Kimball1Mourad Ismail2Department of Medicine, Saint Joseph’s University Medical Center, 703 Main St, Paterson, NJ, USANew York Medical College, Valhalla, NY, USADepartment of Medicine, Saint Joseph’s University Medical Center, 703 Main St, Paterson, NJ, USAA 39-year-old African-American female presented to the emergency department with a seven-day history of right upper quadrant abdominal pain accompanied by nausea, vomiting, and diarrhea. She was noted to be alert and following commands, but tachypneic with Kussmaul respirations; and initial laboratory testing supported a diagnosis of diabetic ketoacidosis (DKA) and hypokalemia. To avoid hypokalemia-induced arrhythmias, insulin administration was withheld until a serum potassium (K) level of 3.3 mEq/L could be achieved. Efforts to increase the patient’s potassium level via intravenous repletion were ineffectual; hence, an attempt was made at more aggressive potassium repletion via hemodialysis using a 4 mEq/L K dialysate bath. The patient was started on Aldactone and continuous veno-venous hemodialysis (CVVH) with ongoing low-dose insulin infusion. This regimen was continued over 24 h resulting in normalization of the patient’s potassium levels, resolution of acidosis, and improvement in mental status. Upon resolution of her acidemia, the patient was transitioned from insulin infusion to treatment with a subcutaneous insulin aspart and insulin detemir, and did not experience further hypokalemia. Considering our success, we propose CVVH as a tool for potassium repletion when aggressive intravenous (IV) repletion has failed.http://dx.doi.org/10.1155/2019/6130694 |
| spellingShingle | Zainab Syed Thomas Kimball Mourad Ismail Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient Case Reports in Critical Care |
| title | Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient |
| title_full | Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient |
| title_fullStr | Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient |
| title_full_unstemmed | Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient |
| title_short | Successful Use of Renal Replacement Therapy for Refractory Hypokalemia in a Diabetic Ketoacidosis Patient |
| title_sort | successful use of renal replacement therapy for refractory hypokalemia in a diabetic ketoacidosis patient |
| url | http://dx.doi.org/10.1155/2019/6130694 |
| work_keys_str_mv | AT zainabsyed successfuluseofrenalreplacementtherapyforrefractoryhypokalemiainadiabeticketoacidosispatient AT thomaskimball successfuluseofrenalreplacementtherapyforrefractoryhypokalemiainadiabeticketoacidosispatient AT mouradismail successfuluseofrenalreplacementtherapyforrefractoryhypokalemiainadiabeticketoacidosispatient |