A 21-year-old man with insulin-dependent (type 1) diabetes mellitus who forgot to inject his insulin is seen in the emergency department. The following laboratory data are obtained:
Serum [Na+] = 140 mEq/L (normal: 135 to 147 mEq/L)
Serum [K+] = 6.5 mEq/L (normal: 3.5 to 5.0 mEq/L)
Serum [HCO3-] = 10 mEq/L (normal: 22 to 28 mEq/L)
Blood pH = 7.0 (normal: 7.35 to 7.45)
Arterial PCO2 = 25 mm Hg (normal: 33 to 44 mm Hg)
Serum [glucose] = 1,000 mg/dL (normal: 70 to 110 mg/dL)
Which of the following plays the most important role in the generation of hyperkalemia in this man?
A. low plasma osmolality
B. low arterial PCO2
C. hyponatremia
D. metabolic acidosis
E. low plasma insulin concentration
ANS: E
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