(261) Clinical and Management Features of Children Presenting With Hypokalemia and Diabetic Ketoacidosis

Introduction: Hypokalemia is a frequent complication during the treatment of diabetic ketoacidosis (DKA). However, its occurrence at the time of admission is relatively uncommon, leading to specific management challenges. This study aimed to describe the demographic, clinical, and management characteristics of pediatric patients presenting with hypokalemia and DKA.

Methods: This retrospective study involved a review of medical records of pediatric patients admitted with DKA and hypokalemia (defined as serum potassium < 3.5 mEq/L) at admission to a tertiary care children’s hospital. Data related to demographics, clinical presentation, laboratory findings, DKA severity, potassium supplements, insulin use, and outcomes (length of stay) were collected and described. Delta gap was calculated using the formula: Na-Cl-36 (Ref: Ann Emerg Med 1991 May;20(5):593). All continuous data are presented as mean (SD).

Results: A total of 13 pediatric patients with DKA and hypokalemia at the time of admission were included in the study. The age of the group was 157 (47) months, and a majority (77%) were children with new-onset type-1-diabetes mellitus (T1DM). The potassium, bicarbonate, anion gap, delta gap, and glucose concentrations at the time of presentation were 3.0 (0.45) mEq/L, 6.0 (1.4) mEq/L, 21.0 (2.5) mEq/L, -9.0 (2.7) mEq/L, 344 (80) mg/dL, respectively. These children received a total of 5.9 (5.2) mEq/kg of potassium and 1.95 (0.98) U/kg of insulin during their hospital stay. The duration of insulin infusion was 27 (16.3) hours, and the hospital length of stay was 5.2 (3.6) days.

Conclusions: Hypokalemia upon hospital admission is rare in children with DKA and is mostly observed in those with new-onset T1DM. Mixed acidosis with concurrent non-gap acidosis is common, indicating prolonged ketonuria before clinical presentation. Correcting this condition often requires substantial potassium supplements.