Phosphate replacement during treatment of diabetic ketosis. Effects on calcium and phosphorus homeostasis

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.