Which electrolyte abnormality is most common in the early phase after burns and why?

• A. Hyperkalemia due to massive cell lysis; followed by possible hypokalemia with diuresis.
• B. Hypercalcemia due to bone resorption.
• C. Hyponatremia due to dilution.
• D. Hypokalemia due to renal losses.

Answer: (D)

In the early burn-care period, potassium balance shifts as the body responds to injury and fluid therapy. Damaged cells release potassium, so an initial rise in serum potassium can occur. However, as fluid resuscitation progresses and diuresis begins, the kidneys excrete potassium, making hypokalemia a common problem early on. This renal potassium loss during the diuretic phase is a typical feature clinicians monitor for and treat with potassium supplementation to prevent depletion. While an early hyperkalemia from cell lysis can happen, the ongoing and clinically important disturbance in the initial management phase is the potassium loss in urine leading to hypokalemia. Other options are less characteristic of the very early burn period.