Incidence and Clinical Outcomes of Hypophosphatemia in Patients with Diabetic Ketoacidosis Admitted to a Tertiary Care Hospital

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus characterized by hyperglycemia, ketosis, and acidosis. Hypophosphatemia is a frequently overlooked yet clinically significant electrolyte disturbance during DKA management. This study aimed to determine the incidence of hypophosphatemia in DKA patients and assess its association with clinical outcomes. Method: A descriptive cross-sectional study was conducted over six months 1st February, 2025 to 31st July, 2025 at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar. A total of 150 patients aged ≥15 years admitted with DKA were enrolled using non-probability consecutive sampling. Serum phosphate levels were measured at admission and 24 hours after insulin therapy. Hypophosphatemia was defined as serum phosphate <2.5 mg/dL. Clinical outcomes such as muscle weakness, respiratory distress, altered consciousness, arrhythmias, ICU admission, and duration of hospitalization were recorded. Data were analyzed using SPSS version 26. Chi-square test and Mann–Whitney U test were applied. Results: Hypophosphatemia was observed in 58.7% of DKA patients. Muscle weakness was significantly more common in hypophosphatemic patients (p = 0.026). Although altered consciousness, arrhythmias, and respiratory distress were more prevalent in this group, the differences were not statistically significant. Mean hospital stay was significantly longer among hypophosphatemic patients (p < 0.001). A significant association was also found between the severity of hypophosphatemia and muscle weakness (p = 0.027). Conclusions: Hypophosphatemia is a prevalent and clinically relevant complication in DKA, associated with increased morbidity and prolonged hospitalization. Routine monitoring and timely management may improve outcomes.