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Hyponatremia is independently associated with a poor prognosis
9%
6/68
Hyperkalemia is independent of the patient's total body potassium stores
50%
34/68
Hyperglycemia to this magnitude supports hyperglycemic hyperosmolar nonketotic syndrome
26%
18/68
Azotemia independently contributes to the patient's encephalopathy
0%
0/68
Hypochloremia to this magnitude supports a pure anion-gap metabolic acidosis
13%
9/68
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This type I diabetic patient has diabetic ketoacidosis (DKA) likely triggered by infection. Her total body potassium stores are independent of the extracellular potassium levels. In diabetic ketoacidosis, the body's total body potassium stores are decreased due to its excretion in the urine from glycosuria. Laboratory workup may suggest that potassium levels are normal, but this may be due to transcellular shift of potassium into the extracellular space in response to the intracellular shift of protons as a physiological attempt to ameliorate the acidemia. Potassium depletion should be assumed and must be repleted in conjunction with hydration and insulin administration. Incorrect Answers: Answer 1: Hyponatremia is not associated with a poor prognosis in DKA. It is often from pseudohyponatremia due to hyperglycemia and hypovolemia. Answer 3: Hyperglycemia greater than 600 mg/dL can support hyperglycemic hyperosmolar nonketotic syndrome, but this patient's history of type 1 diabetes mellitus, low bicarbonate, and anion-gap metabolic acidosis favors DKA as the likely diagnosis. Answer 4: Azotemia does not independently contribute to the patient's encephalopathy. It is from the kidneys' reabsorption of water and the transcellular co-transport of blood urea nitrogen. Answer 5: Hypochloremia does not necessarily support a pure anion-gap metabolic acidosis. This patient has an anion-gap metabolic acidosis and a respiratory alkalosis. Bullet Summary: Total body potassium stores are decreased in diabetic ketoacidosis despite normal or even elevated serum potassium readings.
4.3
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