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NBME 21 Answers

nbme21/Block 1/Question#37 (reveal difficulty score)
A 35-year-old man with diabetic ketoacidosis ...
Serum potassium concentration ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

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submitted by โˆ—nala_ula(126),
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nI iabtedic oticdkesosi,a htree si sandcerei cida in eth xacalrutellre .pasec oArnidccg to FA hteer is a llrearuascltn tsfih ude ot aedseercd niliuns atht ealds to oerm H+ iregnent eht lcle in xaeecgnh rfo K.+ sTih lsdea to ayeipmlahrek hiwt eleddtep iencarlarltul tsreos fo K.+ Trehe si sloa cosomit reisduis ttah ldsae ot ncaesried K+ sosl ni eht ruien and taolt yobd K+ lieon.epdt ehT nusoiteq saks thta is mots lkeily to eeacesrd htwi usinlin ty:rphae uerms spiotausm ntonactnoecri illw seercead as K+ si own gneexchda rof H+ idneis teh

cienfuegos  Additional UW fun facts regarding Potassium and DKA: use caution giving insulin and IV fluids to dehydrated hyperglycemic because i forces K in cells causing fast decrease of extracellular Potassium, thus give K supplementation even when serum K elevated +3  
linwanrun1357  Why urine K+ does not decrease? +3  

This explanation is faulty. Insulin causes K to go inside via upregulating NaKATPase activity. Nothing to with H+ exchange as far as Insulin is concerned.

H and K exchange is separate from this.

+15/- b1ackcoffee(99),

submitted by โˆ—peachespeaches(2),
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I geera ttha Sumre K eardseec is hte treteb werans, ubt ldn'uwot rniUe K aosl reacesed ceno obdol uasgr esgo wnod hitw iisunln tetnmrtae (.ei. tiocsmo sriueisd wudlo )nssle?e

submitted by โˆ—an_improved_me(84),
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sluiInn edos plya a orle in rgingibn bkca K+ onti slelc iva ldniaouomt of +H/K+ hTsi is sucebea ti lhspe ot desdras teh ceaoittcoikd eastt of het tna.piet By nngirgbi pH rcleso to nleb,eais three si tunerr of K+ ntio eht el,lsc hweli H+ eomsc abck uto fo hte ce.sll

an_improved_me  However, you are right, in that too my knowledge, that is not the main way insulin influences K+; it is more via the NaATPase as you have mentioned. +1  

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