The higher proportion of patients with hypokalemia might be associated with poor adherence to the protocol guidance on potassium supplementation (23).The high incidence of hypokalemia or hyperkalemia in this study highlighted the complex interplay between initial hyperkalemia due to acidemia and insulin deficiency, and subsequent rapid declines in serum potassium following insulin therapy, particularly in severe DKA. Here, INS is linked to Hyperkalemia.