A patient with diabetes ketoacidosis (DKA) may have hypophosphatemia. Hypophosphatemia is associated with many of the triggers for ketoacidosis.
Predictors for hypophosphatemia
(1) severe DKA (with severe acidosis)
(2) starvation or malnutrition
(3) burns
(4) alcoholism
(5) sepsis
(6) corticosteroids
(7) vomiting
(8) low serum bicarbonate
The serum phosphate tends to fall during treatment so should be monitored during resuscitation.
The presence of hypophosphatemia may be associated with:
(1) rhabdomyolysis
(2) respiratory failure
(3) impaired neurologic function including seizures
(4) cardiac arrhythmias
Reversal of a complication after phosphate repletion is used as evidence for a causal relationship.
Phosphate should be administered if the hypophosphatemia becomes moderate or severe.
