Endocrine Abstracts

Introduction: Diabetic ketoacidosis (DKA) is an extreme metabolic state caused by insulin deficiency. Hypophosphatemia in DKA often occurs during hospitalization. The aim of this study was to determine the prevalence and determinants of hypophosphatemia during the treatment of diabetic ketoacidosis.

Methods: This is a retrospective cross-sectional descriptive study concerning all patients hospitalized in the Endocrinology Department for DKA between October 2021 and January 2022. Glycemia at presentation and phosphatemia levels during treatment were determinated on AU 680® Beckman Coulter. Glycosylated haemoglobin (HbA1c) levels were determined on ADAMS ® ARKRAY at presentation. Hypophosphatemia was defined as measured serum phosphate less than 0.8 mmol/l. The treatment phase was defined as 1.5 hours from admission to the end of the treatment.

Results: A total of 30 patients were hospitalized for DKA. The mean age of the group was 26.73 ±10.41years, 60% (18/30) of the cases was female. Type 1 diabetes was observed in 63.3% of patients. There were 33.4% newly diagnosed diabetes. Phosphore levels were measured during the treatment phase in 21 cases. The mean phosphate levels was 0.877 mmol/l (range 0.2 to 1.59; SD±0.37 ). Hypophosphatemia (<0.8 mmol/l) was present in 33% (7/21) and severe hypophosphatemia (<0.32 mmol/l) in 14% (3/21). None of the patients suffered from symptoms related to hypophosphatemia. Means glycemia and HbA1c in the group who presented hypophosphatemia and for the group with normal phosphate during the treatment were similarly high 23.52±18.44 mmol/l; 13.45±1.92% and 18.26±7.46 mmol/l; 12.86±3.08% (P=0.29; P=0.334) respectively. Means of duration of insulin therapy were 40.42±20.44 hours and 31.12±20.36 hours (P=0.85) respectively for the group who presented hypophosphatemia and for the group with normal phosphate during the treatment. The group who presented hypophosphatemia during the treatment received statistically similar total insulin dose infusion 80.85 ±40.88 units vs 62.25 ±40.72 units; (P=0.85).

Conclusion: Hypophosphatemia was present in 33% of patients with DKA during treatment The systematic and repeated measurements of phosphate levels are necessary in monitoring patients during treatment.