Why is potassium monitoring critical during DKA treatment?

• A. Potassium shifts can cause dangerous hypokalemia when insulin and fluids are given
• B. Potassium levels do not change
• C. Potassium causes acidosis
• D. Potassium is irrelevant

Answer: (A)

Potassium monitoring is essential because treating DKA with insulin and IV fluids causes potassium to move from the blood into the cells. In DKA, total body potassium is usually depleted from shifts and losses, even if serum potassium looks normal or high. As insulin is started and acidosis improves, potassium shifts intracellularly, and the serum level can fall rapidly. That sudden drop can lead to dangerous heart rhythms, so we monitor potassium closely and replace it as needed. If potassium is very low, insulin may be delayed until potassium is corrected; if it’s moderately low, potassium is given with insulin, and if it’s high, insulin can be started with careful potassium tracking.