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BMJ Case Reports 2012; doi:10.1136/bcr-2012-007312
  • Reminder of important clinical lesson

Hypokalaemia and refractory asystole complicating diabetic ketoacidosis, lessons for prevention

  1. Imad Hassan1
  1. 1Department of Internal Medicine, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
  2. 2Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri, Columbia, Missouri, USA
  3. 3Division of Endocrinology, Department of Internal Medicine, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
  1. Correspondence to Dr Salman Abdulaziz, dr-salman{at}hotmail.com

Summary

We report a unique case of diabetic ketoacidosis in which a relatively low potassium level on admission was associated with consequent life-threatening and refractory arrhythmia secondary to inappropriate use of intravenous insulin and bicarbonate therapy. The latter was reversed by rapid bolus potassium injection. Although we do not advocate this approach in every case, we emphasise that a bolus injection of potassium may be life saving in such cases. The lessons from this case have led to multidisciplinary meetings and modification of the institute's diabetic ketoacidosis clinical pathway.

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