Patient who is age of 65 is suffering from Hyperglycemic Hyperosmolar Nonketotic Syndrome has elevated levels of Potassium levels on serum electrolytes, But has total body potassium depletion ?
what is the mechanism ?
Dear Muhammad,
Your patient is insulin deficient, has mobilized significant amount of potassium to the extracellular compartment and lost significant amount in the urine secondary to osmotic diuresis. He is potassium depleted but hyperkalemic. When you treat him with insulin you are going to cause hypokalemia. This is why K replacement is included in DKA and NKHC protocols.
Article Hypertonicity: Clinical entities, manifestations and treatment
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Hyperglycemic hyperosmolar nonketotic syndrome associated with an elevated blood glucose level and hyperosmolar extracellular fluid (ECF) without the production and accumulation of a mass amount of ketones in the blood.
The change in the serum osmotic pressure may cause potassium, sodium, chloride, phosphate, magnesium and bicarbonate to be depleted from the tissues, even though the serum electrolyte levels may appear to be normal or elevated. Sodium, potassium, phosphate and magnesium are typically lost during the osmotic diuresis leading to electrolyte imbalances.
What is the serum creatinine level & what are the drugs , he is taking ? Insulin deficiency is the cause of hyperkalemia , but other associated factors , such as AKI & Type 4 RTA must be also ruled out .
@Singh Shivakumar
Sir, patient is diabetic and has Hyperkalemia.
what is the probable mechanism of insulin deficiency and potassium rise in serum ?
In HHS , there is insulin deficiency which causes hyperglycemia , but adequate production to prevent ketosis ( different from DKA in T1DM , in which there is no insulin production ) . Insulin deficiency causes efflux of potassium from the cells causing hyperkalemia . In addition , volume depletion due to osmotic diuresis causes AKI which can cause hyperkalemia . T2DM can cause hyperglycemia due to insulin resistance & later insulin deficiency , which can cause HHS .
Hi Muhammad,, hyperglycemic hyperosmolar nonketotic syndrome patients are usually havę hypokalemia. So potassium replacement should be done during insulin therapy to prevent further hypokalemia and arrhythmia. Hyperkalemia in your case may be because of associated acute kidney injury, severe insulin defficency or resistance or effect of any drugs. Thanks
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