In diabetic ketoacidosis, hyperkalemia may develop as a result of metabolic acidosis, insulin deficiency, and reduced renal excretion. Hyperkalemia usually accompanies a large whole-body potassium deficit. It is unusual for extreme methods of potassium control to be needed, and potassium levels will usually return to normal with replacement of the volume and insulin deficits. Very occasionally it is necessary to give calcium chloride or gluconate for myocardial protection, and a period of hemofiltration or dialysis may be required in patients with coexistent oliguric renal failure. In most patients it is necessary to start potassium replacement as plasma potassium levels fall into the upper part of the normal range; thereafter plasma potassium levels should be checked frequently (every 1-2 h).
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