{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:05:02Z","timestamp":1793639102015,"version":"4.5.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic ketoacidosis (DKA) is a severe hyperglycemic emergency characterized by metabolic acidosis and electrolyte disturbances. The optimal strategy for potassium replenishment in DKA remains incomplete. This study comprehensively characterized potassium disturbances in DKA and evaluated the effectiveness of potassium replenishment strategies, with a focus on the risk of hypokalemia during treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicentre retrospective cohort study, we enrolled the consecutive DKA patients admitted to seven tertiary centres across eastern, central and western China (1 January 2021\u201331 December 2023). Demographics, biochemical parameters and daily potassium chloride (KCl) replenishment were extracted and evaluated. We used multivariable logistic regression to identify predictors of hypokalaemia during treatment, internally validated the model, and constructed a practical nomogram.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 571 eligible subjects were included in the analysis. On admission, blood glucose, arterial pH, HCO\n                      <jats:sub>3<\/jats:sub>\n                      <jats:sup>-<\/jats:sup>\n                      , and electrolyte profiles were seriously deteriorated. Among the patients, 95 patients (16.6%) were hypokalemic, 352 (61.6%) normokalemic and 124 (21.7%) hyperkalemic. Hyperkalemia was more frequent in severe DKA and associated with renal impairment and the severity of DKA (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05). During treatment, 388 (67.9%) patients developed hypokalemia, the proportion rose to 73.6% among severe DKA cases. The occurrence of hypokalemia during treatment was independently associated with potassium concentration, HbA1c, and arterial pH at admission (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05). The statistical model predicted the risk of hypokalemia during treatment. A daily 6.0\u00a0g KCl supplement offered superior predictive efficacy for hypokalemia compared to lower doses throughout the treatment course.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Potassium imbalances were highly prevalent in DKA. Although hyperkalemia was more common on admission, hypokalemia frequently developed during treatment. Daily 6.0\u00a0g KCl replenishment was superior to lower doses in predicting hypokalaemia. This study provided the full spectrum of potassium disorders in DKA and delivered an evidence-based, patient-specific replenishment framework.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1669400","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T05:22:04Z","timestamp":1762147324000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Real-world insights from acute management of potassium disorders in diabetic ketoacidosis"],"prefix":"10.3389","volume":"16","author":[{"given":"Yue","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manli","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangfang","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingguang","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqing","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaogang","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yigen","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.16282","article-title":"A systematic literature review on the burden of diabetic ketoacidosis in type 2 diabetes mellitus","volume":"27","author":"Wysham","year":"2025","journal-title":"Diabetes Obes Metab"},{"key":"B2","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.jcjd.2021.10.010","article-title":"Comparison of adult diabetic ketoacidosis treatment protocols from canadian emergency departments","volume":"46","author":"Zheng","year":"2022","journal-title":"Can J Diabetes"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.7754\/Clin.Lab.2020.200309","article-title":"Clinical analysis of electrolyte disorders in patients with diabetic ketoacidosis","volume":"67","author":"Su","year":"2021","journal-title":"Clin Lab"},{"key":"B4","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.ejim.2023.07.005","article-title":"Management of diabetic ketoacidosis","volume":"117","author":"Barski","year":"2023","journal-title":"Eur J Intern Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.disamonth.2022.101418","article-title":"Diabetic ketoacidosis","volume":"69","author":"Calimag","year":"2023","journal-title":"Dis Mon"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S432220","article-title":"Outcome of diabetic keto acidosis treatment and associated factors among adult patients admitted to emergency and medical wards at st. Paul\u2019s hospital, addis ababa Ethiopia, 2023: a cross-sectional study","volume":"16","author":"Derse","year":"2023","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1177\/11795514211004957","article-title":"Diabetic ketoacidosis management and treatment outcome at medical ward of shashemene referral hospital, Ethiopia: a retrospective study","volume":"14","author":"Taye","year":"2021","journal-title":"Clin Med Insights: Endocrinol Diabetes"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2013\/967097","article-title":"The impact of hyperglycemic emergencies on the kidney and liver","volume":"2013","author":"Bai","year":"2013","journal-title":"J Diabetes Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/s41572-020-0165-1","article-title":"Diabetic ketoacidosis","volume":"6","author":"Dhatariya","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"B10","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1016\/j.echo.2017.01.017","article-title":"Dobutamine stress echocardiography: impact of abnormal blood potassium levels on cardiac arrhythmias","volume":"30","author":"Bird","year":"2017","journal-title":"J Am Soc Echocardiography"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006040368","article-title":"Modified glomerular filtration rate estimating equation for chinese patients with chronic kidney disease","volume":"17","author":"Ma","year":"2006","journal-title":"J Am Soc Nephrol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.jcjd.2018.11.003","article-title":"Acute management of diabetic ketoacidosis in adults at 3 teaching hospitals in Canada: a multicentre, retrospective cohort study","volume":"43","author":"Galm","year":"2019","journal-title":"Can J Diabetes"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1530\/EC-18-0109","article-title":"Hypokalemia: a clinical update","volume":"7","author":"Kardalas","year":"2018","journal-title":"Endocrine Connections"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgae201","article-title":"Renal hypokalemia: an endocrine perspective","volume":"109","author":"Culver","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.20452\/pamw.15634","article-title":"Prevention of hypokalemia induced adverse cardiovascular effects in diabetic ketoacidosis: a novel role of pH-adjusted potassium","volume":"130","author":"Usman","year":"2020","journal-title":"Pol Arch Intern Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2021.03.001","article-title":"Re-visiting pH-adjusted potassium to avoid hypokalemic crisis during management of diabetic ketoacidosis: a conceptual framework","volume":"15","author":"Usman","year":"2021","journal-title":"Diabetes Metab Syndr: Clin Res Rev"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-26.6.592","article-title":"Potassium-containing fluids for diabetic ketoacidosis","volume":"26","author":"Guise","year":"2021","journal-title":"J Pediatr Pharmacol Ther"},{"key":"B18","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.jpeds.2020.08.085","article-title":"QTc prolongation in pediatric patients with diabetic ketoacidosis","volume":"228","author":"Perez","year":"2021","journal-title":"J Pediatr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e14315","DOI":"10.1111\/ijcp.14315","article-title":"Mapping the role of pH-adjusted potassium in diabetic ketoacidosis: hypokalemia and the patient outcomes","volume":"75","author":"Usman","year":"2021","journal-title":"Int J Clin Pract"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58030431","article-title":"Hypokalemia in diabetes mellitus setting","volume":"58","author":"Coregliano-Ring","year":"2022","journal-title":"Med (Mex)"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab029","article-title":"Potassium concentration in initial fluid therapy and In-hospital mortality of patients with diabetic ketoacidosis","volume":"106","author":"Okada","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1168","article-title":"Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study","volume":"43","author":"Pasquel","year":"2020","journal-title":"Diabetes Care"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcte.2019.100188","article-title":"Clinical characteristics and outcomes of care in adult patients with diabetic ketoacidosis: a retrospective study from a tertiary diabetes center in Thailand","volume":"16","author":"Thewjitcharoen","year":"2019","journal-title":"J Clin Transl Endocrinol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.13994","article-title":"Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes","volume":"318","author":"Karges","year":"2017","journal-title":"JAMA"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30042-5","article-title":"Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes","volume":"8","author":"Ehrmann","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000002859","article-title":"Is HbA1c an indicator of diabetic ketoacidosis severity in the pediatric population","volume":"39","author":"Lamsal","year":"2023","journal-title":"Pediatr Emer Care"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1669400\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T05:22:05Z","timestamp":1762147325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1669400\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":26,"alternative-id":["10.3389\/fendo.2025.1669400"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1669400","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,3]]},"article-number":"1669400"}}