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nbme21/Block 1/Question#37 (21.8 difficulty score)
A 35-year-old man with diabetic ketoacidosis ...
Serum potassium concentrationπŸ”,πŸ“Ί

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submitted by nala_ula(112),
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nI aecibdit oiiedctsa,sko ereht si ensaedric idac ni het ceeaulrxartll .ceasp crngiocdA to AF teerh si a csaraurlelntl fhtis edu ot dseecadre nnlisui ttah slead ot oemr +H etrennig hte clel ni ehegxnca rfo .+K hsTi aldse ot mlpiakheaeyr hwti pleedtde urtnacllilera stoesr fo .K+ rThee is losa tomscoi dsiiersu hatt delas to aneiscedr +K sols ni het rieun nad aotlt doyb +K elndtepio. Teh etunqsio ksas atth is msto ilkeyl to ereadecs wiht lsnniiu te:phray rmesu paosistmu trienatncoocn wlil asederce sa K+ is own neechdgxa orf H+ iidsen hte lcle.

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.

+12/- b1ackcoffee(49),

submitted by an_improved_me(16),


Insulin does play a role in bringing back K+ into cells via modulation of K+/H+ exchange. This is because it helps to address the ketoacidotic state of the patient. By bringing pH closer to baseline, there is return of K+ into the cells, while H+ comes back out of the cells.

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. +