Electrolyte Imbalance in Diabetic Ketoacidosis

A patient speaking with her doctor.
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If you have diabetes, it's important to be familiar with diabetic ketoacidosis (DKA). DKA is a serious complication of diabetes that occurs when lack of insulin and high blood sugar lead to potentially life-threatening chemical imbalances. The good news is DKA is largely preventable. Although DKA is more common with type 1 diabetes, it can also occur with type 2 diabetes. High blood sugar causes excessive urination and spillage of sugar into the urine. This leads to loss of body water and dehydration as well as loss of important electrolytes, including sodium and potassium. The level of another electrolyte, bicarbonate, also falls as the body tries to compensate for excessively acidic blood.


Bicarbonate and Acidosis

Insulin helps blood sugar move into cells, where it is used for energy production. When insulin is lacking, cells must harness alternative energy by breaking down fat. Byproducts of this alternative process are called ketones. High concentrations of ketones acidify the blood, hence the term "ketoacidosis." Acidosis causes unpleasant symptoms like nausea, vomiting and rapid breathing. Bicarbonate is an electrolyte that normally counteracts blood acidity. In DKA, the bicarbonate level falls as ketone production increases and acidosis progresses. Treatment of DKA includes prompt insulin supplementation to lower blood sugar, which leads to gradual restoration of the bicarbonate level.


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Potassium may be low in DKA because this electrolyte is lost due to excessive urination or vomiting. When insulin is used to treat DKA, it can further lower the blood potassium by pushing it into cells. Symptoms associated with low potassium include fatigue, muscle weakness, muscle cramps and an irregular heart rhythm. Severely low potassium can lead to life-threatening heart rhythm abnormalities. Frequent monitoring and timely correction of a low potassium can be lifesaving. Potassium can be taken orally, but in DKA, intravenous infusion is the best way to replenish potassium rapidly.



Sodium is essential for maintaining a stable blood pressure and fluid balance in the body. High blood sugar causes excessive urination with loss of body water and sodium. This can cause dehydration and low blood pressure. When the body needs to restore water to the bloodstream, it does so by pulling it from other tissues. This influx of water into the bloodstream may cause blood sodium to be further diluted. A low sodium level can cause symptoms of dizziness, fatigue, general weakness and, if severe, mental confusion or seizures. Insulin and intravenous fluids containing sodium chloride are used to treat the sodium deficit caused by DKA.


Prevention and Caution

DKA is a serious but preventable condition. Frequent monitoring of blood sugar, adhering to prescribed medicines and recognizing early warning signs are key elements of prevention. Common symptoms to watch for include nausea, vomiting, abdominal pain and shortness of breath. Checking for ketones in the blood or urine using a home testing kit can also help with early detection of DKA.


It is important to regularly consult with your doctor to establish blood-sugar goals. During times of stress or illness, more frequent monitoring may be necessary as blood sugar tends to fluctuate. Seeking prompt medical attention for early warning signs of DKA can prevent serious complications.



references & resources

Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.

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