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Hypokalaemia during HHS treatment — SCE Endocrinology MCQ

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HardDiabetic emergenciesHypokalaemia during HHS treatmentSCE Endocrinology

A 71-year-old woman with type 2 diabetes is treated for HHS. Initial potassium is 5.4 mmol/L, but after fluids and insulin it falls to 2.9 mmol/L with ventricular ectopy. eGFR is 44 ml/min/1.73 m2. What is the most appropriate management?

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Correct answer: A — Pause insulin temporarily and give intravenous potassium replacement with cardiac monitoring

Pause insulin temporarily and give intravenous potassium replacement with cardiac monitoring is best because total body potassium is depleted in HHS and insulin can unmask dangerous hypokalaemia requiring replacement and insulin adjustment. The alternatives are less appropriate because the initial potassium is misleading; bicarbonate does not solve depletion; fluid restriction risks ongoing hyperosmolality; levothyroxine is irrelevant. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: JBDS-IP HHS guideline