Journal of Clinical Endocrinology & Metabolism, Vol 57, 177-180, Copyright © 1983 by Endocrine Society

ARTICLES

A randomized study of phosphate therapy in the treatment of diabetic ketoacidosis

JN Fisher and AE Kitabchi

The use of phosphate therapy in the management of diabetic ketoacidosis (DKA) has been controversial, particularly with respect to the effect of phosphate intermediates on tissue oxygenation. In a prospective randomized study we evaluated the effect of phosphate (8.5 mmol/h or approximately 6 g phosphate/24 h) (experimental group) vs. no phosphate therapy (control group) in 30 DKA patients, 15 in each group. Various determinations including erythrocyte 2,3-diphosphoglycerate (2,3-DPG), oxyhemoglobin dissociation (p50), serum phosphate, calcium, lactate, pyruvate, electrolytes, and response time to reach predetermined values for glucose, bicarbonate, and pH were measured at frequent intervals during the first 24 h of therapy and daily for 5 days after metabolic control. Initial electrolytes, glucose, pH, erythrocyte 2,3-DPG, lactate, and p50 were not different in either group. Whereas the experimental group had a greater level of 2,3-DPG than the control group by 48 h, the difference was not statistically significant. Recovery indices, including hours to reach glucose of 250 mg/dl, bicarbonate greater than 15 meq/liter, pH greater than 7.3, and mental alertness, were not different in the two groups nor were the p50 or lactate measurements. The experimental group exhibited significantly lower plasma ionized calcium values during therapy. We conclude that phosphate therapy may accelerate regeneration of erythrocyte 2,3-DPG but in the relatively small number of patients studied it had no demonstrable influence on tissue oxygenation or clinical response to low dose insulin therapy of DKA. Furthermore, the exaggeration of hypocalcemia seen in phosphate-treated patients may be reason for caution in the use of such therapy.

This article has been cited by other articles:

				Endocrinology & Metabolism News, May 2008 J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 17a - 17a. [Full Text] [PDF]

				A. E. Kitabchi, G. E. Umpierrez, J. N. Fisher, M. B. Murphy, and F. B. Stentz Thirty Years of Personal Experience in Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1541 - 1552. [Abstract] [Full Text] [PDF]

				M. Sheikh-Ali, B. S. Karon, A. Basu, Y. C. Kudva, L. A. Muller, J. Xu, W. F. Schwenk, and J. M. Miles Can Serum {beta}-Hydroxybutyrate Be Used to Diagnose Diabetic Ketoacidosis? Diabetes Care, April 1, 2008; 31(4): 643 - 647. [Abstract] [Full Text] [PDF]

				S. M. Brunelli and S. Goldfarb Hypophosphatemia: Clinical Consequences and Management J. Am. Soc. Nephrol., July 1, 2007; 18(7): 1999 - 2003. [Abstract] [Full Text] [PDF]

				T Kearney and C Dang Diabetic and endocrine emergencies Postgrad. Med. J., February 1, 2007; 83(976): 79 - 86. [Abstract] [Full Text] [PDF]

				A. E. Kitabchi, G. E. Umpierrez, M. B. Murphy, and R. A. Kreisberg Hyperglycemic Crises in Adult Patients With Diabetes: A consensus statement from the American Diabetes Association Diabetes Care, December 1, 2006; 29(12): 2739 - 2748. [Full Text] [PDF]

				J. Wolfsdorf, N. Glaser, and M. A. Sperling Diabetic Ketoacidosis in Infants, Children, and Adolescents: A consensus statement from the American Diabetes Association Diabetes Care, May 1, 2006; 29(5): 1150 - 1159. [Full Text] [PDF]

				P English and G Williams Hyperglycaemic crises and lactic acidosis in diabetes mellitus Postgrad. Med. J., May 1, 2004; 80(943): 253 - 261. [Abstract] [Full Text] [PDF]

				D B Dunger, M A Sperling, C L Acerini, D J Bohn, D Daneman, T P A Danne, N S Glaser, R Hanas, R L Hintz, L L Levitsky, et al. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents Arch. Dis. Child., February 1, 2004; 89(2): 188 - 194. [Abstract] [Full Text]

				D. B. Dunger, M. A. Sperling, C. L. Acerini, D. J. Bohn, D. Daneman, T. P.A. Danne, N. S. Glaser, R. Hanas, R. L. Hintz, L. L. Levitsky, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society Consensus Statement on Diabetic Ketoacidosis in Children and Adolescents Pediatrics, February 1, 2004; 113(2): e133 - 140. [Full Text] [PDF]

				Hyperglycemic Crises in Diabetes Diabetes Care, January 1, 2004; 27(90001): s94 - 102. [Full Text] [PDF]

				R D Hardern and N D Quinn Emergency management of diabetic ketoacidosis in adults Emerg. Med. J., May 1, 2003; 20(3): 210 - 213. [Abstract] [Full Text] [PDF]

				J.-L. Chiasson, N. Aris-Jilwan, R. Belanger, S. Bertrand, H. Beauregard, J.-M. Ekoe, H. Fournier, and J. Havrankova Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state Can. Med. Assoc. J., April 1, 2003; 168(7): 859 - 866. [Abstract] [Full Text] [PDF]

				Hyperglycemic Crises in Patients With Diabetes Mellitus Diabetes Care, January 1, 2003; 26(90001): s109 - 117. [Full Text] [PDF]

				G. E. Umpierrez, M. B. Murphy, and A. E. Kitabchi Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome Diabetes Spectr, January 1, 2002; 15(1): 28 - 36. [Abstract] [Full Text] [PDF]

				American Diabetes Association Hyperglycemic Crises in Patients With Diabetes Mellitus Diabetes Care, November 1, 2001; 24(11): 1988 - 1996. [Full Text] [PDF]

				American Diabetes Association Hyperglycemic Crises in Patients With Diabetes Mellitus Clin. Diabetes, April 1, 2001; 19(2): 82 - 90. [Full Text] [PDF]

				A. E. Kitabchi, G. E. Umpierrez, M. B. Murphy, E. J. Barrett, R. A. Kreisberg, J. I. Malone, and B. M. Wall Management of Hyperglycemic Crises in Patients With Diabetes Diabetes Care, January 1, 2001; 24(1): 131 - 153. [Full Text]

				American Diabetes Association Hyperglycemic Crises in Patients With Diabetes Mellitus Diabetes Care, January 1, 2001; 24(1): 154 - 161. [Full Text]