Skip to main content

Table 5 Studies on potassium balance and supplementation

From: Bicarbonate in diabetic ketoacidosis - a systematic review

Reference Trial design and size Bicarb dose (intervention) Insulin dose Potassium balance and supplementation
Morris et al. [14] RCT 120.4 mmol Insulin 0.3 U/kg (IV + IM), No difference in serum K decline
Ann Intern Med 1986 Adults (N = 21) (mean) then IM 7 U/hr  
Gamba et al. [15] RCT 84 mmol IV insulin 5 U/hr Lower serum K at 24 hr for bicarb arm vs. control,
Rev Cl In 1991 Adults (N = 20) (mean)   p < 0.05
     BUT trend for more K given in control
Soler et al. [22] Prospective Grp 1: none Grp 1: 234 U/24 hr More K requirement over 24 hr for Grp 3
Lancet 1972 Mixed (N = 25) Grp 2: 200 mmol Grp 2: 287 U/24 hr Estimated 30 mmol/L of K needed for Grps 1 & 2,
(3-arm study; age 13-84 yr) Grp 3: 400 mmol Grp 3: 288 U/24 hr & 40 mmol/L for Grp 3
only 2 groups randomized    (per L of fluid infused)
Lutterman et al. [17] Retrospective 167 mmol High-dose insulin (mean No difference in mean serum K
Diabetologia 1979 Adults (N = 24) (standard) 260 ± 60 U in 1st 6 hr) No difference in K requirement over 12 hrs
    vs. low dose 8 U/hr  
Lever et al. [18] Retrospective 130-135 mmol IM or IV insulin No difference in K requirement
Am J Med 1983 Adults (N = 73) (standard) 5-6 U/hr (for all) 6 hypokalemia (< 3.3 mmol/L) in bicarb arm, 1 in control
Viallon et al. [20] Retrospective 120 ± 40 mmol IV insulin for all More K requirement over 24 hr for bicarb arm,
Crit Care Med 1999 Adults (N = 39) (mean) (dose unspecified) p < 0.001
     1 hypokalemia (< 3 mmol/L) in bicarb arm
Green et al. [24] Retrospective 2.08 mmol/kg IV insulin for all No difference in hypokalemia occurrence
Ann Emerg Med 1998 Pediatrics (N = 106) (mean) (dose unspecified)  
  1. Grp = group; IM = intramuscular; IV = intravenous; U = units; K = potassium; bicarb = bicarbonate; L = liter