Phosphate

Phosphate plays an integral role in the conversion of energy from adenosine triphosphate (ATP) and in the delivery of oxygen at the tissue level through 2,3-diphosphoglyceric acid (2,3-DPG). In addition, many important enzymes, cofactors, and biochemical intermediates depend upon phosphate. Phosphate is primarily intracellular, and shifts to the extracellular compartment during DKA. Serum levels are often normal or increased upon presentation, and do not reflect the total body phosphate deficits secondary to enhanced urinary losses. 8 Phosphate (similar to glucose and potassium) reenters the intracellular space during insulin therapy, resulting in low phosphate concentrations. Hypophosphatemia is usually most severe 24 to 48 h after the start of insulin therapy. Acute phosphate deficiency (<1.0 mg/dL) has been associated with a variety of clinical disorders, including hypoxia, rhabdomyolysis, hemolysis, respiratory failure, and cardiac dysfunction. Fortunately, all are extremely rare during therapy of DKA.5

The role of phosphate replacement during the treatment of DKA remains controversial. No clinical trial has demonstrated significant benefits from routine intravenous phosphate therapy.8!4 In general, intravenous therapy should be withheld unless the serum phosphate concentration is less than 1 mg/dL. Hypophosphatemia can be corrected safely and effectively with oral replenishment, which may cause diarrhea.

There is no established role for initiating intravenous potassium phosphate in the ED. Significant hypophosphatemia tends to develop only many hours into therapy, after the patient is already admitted. Several undesirable side effects from intravenous phosphate administration have been reported. These include hyperphosphatemia, hypocalcemia, hypomagnesemia, metastatic soft tissue calcifications, and hypernatremia and volume loss from osmotic diuresis. If deemed necessary (phosphate <1.0 mg/dL early in therapy and/or patient vomiting), intravenous phosphate replacement should be done by, or in consult with, experienced physicians in an ICU setting. Serum phosphate, calcium, and magnesium levels should be monitored during therapy of DKA; but, again, the case for routine early parenteral phosphate replacement has not been made.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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