I was reading about diabetic ketoacidosis(DKA), where it was mentioned about osmotic diuresis caused by glucose within the renal tubules.

Okay, I understand about the fluid loss due to osmotic potential of glucose leading to polyuria.

However, why it is also mentioned about the hypokalemia or sodium loss and chloride as well,

I understand about the insulin decrement and how insulin maintains intracellular potassium concentration, but I can't understand how -

osmotic diuresis will cause loss potassium?

Source :https://en.wikipedia.org/wiki/Osmotic_diuretic

I tried searching for the same, however all mention same line as above, perhaps is there something to do with (my thoughts and hypothesis)

  1. sodium glucose cotransporter causes more sodium loss along with glucose
  2. increased sodium causes its reabsorbtion at collecting tubule and loss of potassium

But can't think about chloride, moreover I'm also worried about apparent hyponatremia because of hypovolemic hypernatremia causes increased sodium excretion.

Or is hypovolemia the main cause that leads to apparent increase in concentration of these ions which causes their increased excretion.


Loss of intracellular free water because of increased plasma osmolality, this causes water to move out of cell.

After this, potassium concentration has increased inside cell, so this causes extracellular movement of potassium (secondary to increased intracellular potassium concentration)

Similar mechanism happens at level of kidney tubules and interstitium.

Source: Uworld step 1 qbank( Q Id 985) (may not be accessible)

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