title: Large phosphate shifts with treatment for hyperglycemia.
abstract: Although hypophosphatemia is known to commonly accompany therapy for hyperglycemia, it is not generally appreciated that severe life-threatening depletion of phosphate may occur. I followed up two patients who had precipitous drops during intravenous insulin therapy for diabetic ketoacidosis and hyperosmolar nonketotic state. The patient with diabetic ketoacidosis had a phosphate level nadir that equaled the lowest recorded phosphate level in a living human (0.03 mmol/L). Because (1) serum phosphate levels do not reflect total body phosphate stores, (2) rapid shifts of phosphorus can occur among body compartments, and (3) severe hypophosphatemia is potentially life-threatening, phosphate levels should be frequently monitored during therapy for hyperglycemia and intervention should be undertaken if phosphate levels fall below 0.5 mmol/L.
authors.affiliation: St Luke's Hospital, San Francisco, Calif.
authors.forename: N J
authors.initials: NJ
authors.lastname: Bohannon
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000628:therapy*; D008297:Male; D010710:Phosphates / Q000097:blood*
chemical_list: D010710:Phosphates