To determine the efficacy of
phosphate replacement in the
therapy for
diabetic ketoacidosis (DKA), 44 patients were randomly assigned to three treatment groups: those who received no
phosphate replacement, those who received 15 mmole of
sodium phosphate at the fourth hour, or those who received 15 mmole of
sodium phosphate at 2, 6, and 10 hours. All patients were treated with intravenous
insulin injection (0.1 units/kg/hr), fluids, and
potassium. Four hours after a 15-mmole
sodium phosphate infusion, the serum
phosphate level was 2.8 +/- 0.8 mg/dL vs 2.1 +/- 0.8 mg/dL in the control patients; however, this dose was insufficient to maintain the serum
phosphate level at 16 and 24 hours. Forty-five millimoles of
phosphate prevented severe
hypophosphatemia in all but one patient and produced substantially higher
phosphate levels at 8, 16, and 24 hours.
Phosphate therapy did not affect the duration of DKA, dose of
insulin required to correct the
acidosis, abnormal muscle
enzyme levels,
glucose disappearance, or morbidity and mortality. Although theoretically appealing,
phosphate therapy is not an essential part of the
therapy for DKA in most patients.