Sanluis Fenelli Gabriela, Bechara Aded Cecilia, Lagger Julieta, Widmer Jesica, Zucaro Florencia, Aparo Victoria, Ferreira Juan Pablo, Ferraro Mabel
Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
Andes Pediatr. 2024 Apr;95(2):183-189. doi: 10.32641/andespediatr.v95i2.4924. Epub 2024 Mar 14.
Diabetic ketoacidosis (DKA) is one of the most serious complications of type 1 diabetes mellitus. Its treatment requires fluid and electrolyte replacement and insulin. Hypophosphatemia as a complication of treatment has been scarcely evaluated.
To estimate the incidence of hypophosphatemia in children with DKA, treated with subcutaneous regular insulin (IRS), and to explore factors associated with this complication.
Prospective, observational study. Patients diagnosed with DKA hospitalized in the general care ward were included. Data on phosphatemia, glycemia, acid-base status, and IRS amount (U/kg) received were recorded at baseline and after 24 h of treatment. Hypophosphatemia was defined as values below 2.5 mg/dl. The correlation between initial phosphate and at 24 h of treatment was evaluated; the incidence of hypophosphatemia at 24 h was expressed as a percentage of the total number of patients.
30 patients were included, 15 were female, mean age 11.4 ± 3.2 years. At 24 h of treatment with IRS, 36.7% (95%CI 22-55%) presented hypophosphatemia, mean value 1.9 ± 1.5 mg/dl. Initial bicarbonate < 10 mmol/L acted as a predictor of hypophosphatemia (OR 7.5; 95%CI 1.4-39.8%; p = 0.01). No patient required intravenous phosphate correction, and no associated clinical complications were observed.
In the group studied, the incidence of hypophosphatemia reached 36.7% at 24 hours of treatment. Initial bicarbonate lower than 10 mmol/L was significantly associated with hypophosphatemia. No complications associated with hypophosphatemia were observed.
糖尿病酮症酸中毒（DKA）是1型糖尿病最严重的并发症之一。其治疗需要补充液体和电解质以及使用胰岛素。作为治疗并发症的低磷血症很少被评估。
评估皮下注射常规胰岛素（IRS）治疗的DKA儿童中低磷血症的发生率，并探讨与该并发症相关的因素。
前瞻性观察性研究。纳入在普通护理病房住院的DKA确诊患者。记录基线时以及治疗24小时后的血磷、血糖、酸碱状态和接受的IRS剂量（U/kg）数据。低磷血症定义为低于2.5mg/dl的值。评估初始磷酸盐与治疗24小时时的相关性；治疗24小时时低磷血症的发生率以患者总数的百分比表示。
纳入30例患者，15例为女性，平均年龄11.4±3.2岁。在使用IRS治疗24小时时，36.7%（95%CI 22 - 55%）出现低磷血症，平均值为1.9±1.5mg/dl。初始碳酸氢盐<10mmol/L是低磷血症的预测指标（OR 7.5；95%CI 1.4 - 39.8%；p = 0.01）。没有患者需要静脉补充磷酸盐，也未观察到相关临床并发症。
在研究组中，治疗24小时时低磷血症的发生率达到36.7%。初始碳酸氢盐低于10mmol/L与低磷血症显著相关。未观察到与低磷血症相关的并发症。
