A patient with diabetic ketoacidosis (DKA) may be depleted in electrolytes other than potassium.
Electrolytes other than potassium that may be low in a patient with diabetic ketoacidosis include:
(1) sodium bicarbonate
(2) magnesium
(3) phosphate
Sodium Bicarbonate: Infusion of sodium bicarbonate is controversial.
(1) If the pH is < 6.9 then consider giving 100 mmol of sodium bicarbonate (2 ampoules) in 400 mL sterile water with 20 mmol/L potassium chloride at a rate of 200 mL per hour for 2 hours.
(2) If the pH is still < 7.0 then the infusion can be repeated every 2 hours until the pH is > 7.0.
Magnesium: The presence of hypokalemia and hypomagnesemia may be associated with increased risk for cardiac arrhythmias. The target for serum magnesium concentration is > 2 mg/dL.
Phosphate depletion may be an issue if some patients, especially those who have been fasting or in severe DKA. It may also fall during therapy of the ketoacidosis.
(1) Replacement should be considered if the serum concentration is below 1.0 mg/dL and if the patient has cardiac dysfunction or respiratory depression.
(2) The maximal replacement rate should be 4.5 mmol per hour using potassium phosphate.
