1. A 45-year-old male with a history of type 1 diabetes mellitus is brought to the emergency

department with altered mental status, nausea, vomiting, and abdominal pain. His blood glucose

level is 450 mg/dL and his urine test shows positive for ketones. He is diagnosed with diabetic

ketoacidosis (DKA) and started on intravenous fluids and insulin infusion. Which of the following

electrolyte imbalances is most likely to occur in this patient?

A) Hyperkalemia

B) Hypokalemia

C) Hypercalcemia

D) Hypocalcemia

Answer: B) Hypokalemia

Rationale: DKA is a state of insulin deficiency that leads to increased breakdown of fat and

protein, resulting in the production of ketone bodies that cause metabolic acidosis. Insulin also

facilitates the uptake of potassium into cells, so insulin deficiency causes potassium to shift out of

cells and into the extracellular fluid. This leads to hyperkalemia initially, but as the patient receives

insulin therapy, potassium moves back into cells and the serum potassium level drops. In addition,

the patient may lose potassium through urine due to osmotic diuresis and vomiting. Therefore,

hypokalemia is a common complication of DKA that requires careful monitoring and replacement.

2. A 60-year-old female with a history of type 2 diabetes mellitus and hypertension presents to the

clinic with polyuria, polydipsia, and blurred vision. Her blood glucose level is 800 mg/dL and her

serum osmolality is 350 mOsm/kg. She is diagnosed with hyperglycemic hyperosmolar state

(HHS) and admitted to the intensive care unit for fluid resuscitation and insulin therapy. Which of

the following factors is most likely to have contributed to the development of HHS in this patient?

A) Infection

B) Medication noncompliance

C) Renal insufficiency