Is Phosphorus Supplementation Systematic in Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a severe acute complication of diabetes, resulting from an insulin deficiency that leads to hyperglycemia, metabolic acidosis, and significant fluid and electrolyte losses, particularly phosphorus. This element plays a crucial role in energy metabolism and bone mineralization. Our study aims to assess the frequency of hypophosphatemia in patients with DKA, analyze the impact of phosphorus supplementation on insulin requirements, and examine its influence on the length of hospitalization in the intensive care unit. This prospective study was conducted over 12 months and included 55 cases of diabetic ketoacidosis admitted to the medical intensive care unit at CHU Ibn Rochd in Casablanca. Serum phosphate levels were measured in all patients, with a median value of 18 mg/L. Based on these levels, our sample was divided into two groups: one with normal phosphatemia and the other with hypophosphatemia. The average age of patients was 43.85 years, with a female predominance. Hypophosphatemia was observed in 56% of patients at admission, requiring systematic intravenous correction, with an average supplementation duration of 8.6 ± 5.4 days. In these patients, a significant reduction in insulin requirements was noted. The average length of hospital stay was 8.9 ± 6.1 days, with a longer stay in the hypophosphatemic group. The overall mortality rate was 29.1%. Hypophosphatemia is frequent in DKA. Its correction through phosphorus supplementation improves glycemic control and may contribute to an optimized management of patients in intensive care by reducing insulin requirements and potentially influencing the length of hospitalization.