In pediatric DKA therapy, which electrolyte imbalance requires careful replacement to prevent cerebral edema?

• A. Sodium imbalance
• B. Magnesium imbalance
• C. Potassium imbalance
• D. Calcium imbalance

Answer: (C)

Potassium balance during pediatric DKA treatment is the key concern because the therapy itself drives rapid shifts of potassium between compartments. At presentation, total body potassium is depleted even if the serum level looks normal or high. When insulin is started and acidosis resolves, potassium moves back into cells, which can cause a dangerous drop in serum potassium (hypokalemia) if replacement isn’t carefully managed. Hypokalemia can lead to life-threatening arrhythmias and muscle weakness, and the rapid intracellular shifts can amplify osmotic changes in brain tissue, contributing to cerebral edema risk. Therefore, potassium replacement must be tailored and closely monitored as insulin and fluids are administered, to keep potassium in a safe range and prevent these complications.