Phosphate replacement during treatment of diabetic ketosis. Effects on calcium and phosphorus homeostasis
D. J. Becker, D. R. Brown, B. H. Steranka and A. L. Drash
Thirty-five patients with diabetic ketosis were given initial intravenous
(IV) potassium replacement as phosphate (N = 13) or chloride (N = 13), or
received no potassium replacement other than that contained in a normal
diet (N = 9). All patients experienced a slight decrease in serum calcium
level by 12 hours after the start of insulin therapy, but there was no
statistically significant change in serum ionized calcium values. The
phosphorus-supplemented group had significantly lower serum phosphorus
concentrations at 24 and 36 hours when compared with patients receiving no
IV hydration and excreted significantly more phosphorus during the first 12
hours of the study than either of the other two groups of patients. Our use
of phosphorus supplements (4.7 to 28.5 mg/kg) did not cause abnormalities
in calcium metabolism but did not prevent late hypophosphatemia.
