What did you guys put for the kid with DKA and they asked what can cause the cardiac arrest? I dont remember all the answer choices but I was flipping between Potassium (usual cause of arrythmias but it was just a little low) or acetone which i have no idea what it does on the heart. Or was it one of the other answer choices?
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Step I Question from NBME 3---spoiler
Started by maswe12
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I haven't taken any of the NBME tests, so I don't know what the question was, but if it was refering to a situation where a DKA patient was being treated, then it was probably potassium. I think once you start to correct for the volume depletion and then give some insulin, they will become hypokalemic unless you give extra K+. I think there are two reasons why this happens. 1) insulin causes muscles to take up K+ and 2) the transcellular shift of K+ back into RBCs in exchange for H+ when coming out of the acidosis. Does that sound right? Any other reasons besides these two?
Yes, having Hyperkalemia would be the likely culprit in causing cardiac arrest in someone with DKA. Alluding to your other point about total body K stores, you correctly stated that DKA patients are actually K depleted. The main reason is that in DKA you spill your K stores into your urine, with the huge osmotic diuresis. Insuln related K uptake, and H+/K+ pumping are probably a small mechanism. You also must remember that a patient presenting to the ED in DKA will have low total body K (IC+EC) BEFORE any treatment with insulin. A general rule is if their K is <4.5 then you need to give put 10 meq K in the bag of NS because they can get hypokalemic in a hurry. If their K is 4.5.-6.5 do nothing until it gets below 4.5, and if K> 6.5 get an EKG and give Calcium. The K goes up initially due to H+/K+ pumping.
Thanks...I figured but wanted to find out what acetone does. I had another question that i wasnt too sure about--found this on another website but no consensus.
16 yr boy brought to doc coz he is shorter than peers.he is proportionately developed other wise.xray of wrist is take,which of the findings show that his growth is complete:
a.absence of epiphyseal cartilage plate
b.absence of primary ossification centre
c.presence of calcified material in epiphysis
d.in diaphysis
e.presesne of lines of arrested growth
16 yr boy brought to doc coz he is shorter than peers.he is proportionately developed other wise.xray of wrist is take,which of the findings show that his growth is complete:
a.absence of epiphyseal cartilage plate
b.absence of primary ossification centre
c.presence of calcified material in epiphysis
d.in diaphysis
e.presesne of lines of arrested growth
