Abstract
Aim: The aim of the study was to access mortality in Diabetic Keto Acidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS)with special reference to serum Phosphate levels.
Methods: It was a across sectional study conducted on patients with Type 1 and type 2 Diabetes Mellitus (DM), admitted with DKA and HHS in emergency ward and Intensive care unit of a tertiary care hospital in Bengaluru, during the period September 2014 to August 2015.Serum phosphate levels were measured in all the patients on day 0, day 1 and before discharge or death . Patients were treated as per the standard protocol. Type 1 and Type 2 DM patients were identified separately. Patients with DKA and HHS were also put in two separate groups. Mortality in the two groups was correlated with serum Phosphate levels by applying Chi Square test.
Results: We had 31 males and 19 female patients. Out of them 16 belonged to type 1 DM and 34 were type 2 DM. 39 of the 50 patients had DKA and 11 had HHS. Infection and noncompliance of treatment were the major precipitating factors of DKA /HHS. 6 patients (12%) expired. Mean phosphate level in the mortality group was 2.14 mg% and 3.03 mg% in those who survived. 93% of the patients who recovered had normal phosphate levels at discharge, where as 83% of the patients in the mortality group had low serum phosphates.
Conclusion: Though Phosphate therapy is not routinely required during the treatment of acute Diabetic Hyperglycemic emergencies, they should not be ignored. If hypophosphatemia is severe or if the patient develops cardio respiratory distress, phosphate should be administered under close supervision.
Key words: Diabetic ketoacidosis, Hyperglycemic hyperosmolar state, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Serum Phosphate levels,
References
1. Coli Bauer, AnahatDhillon. Hypo phosphatemia and hyperphosphatemia. http://clinicalgate.com/hypophosphatemia- and -hyperphosphatemia
2. Shiber J R,Mattu A. Serum phosphate abnormalities in the emergency depart-ment. J Emerg Med.2002Nov;23(4):395-400
3. Barton S Levine, Arnold J Felsenfeld. Acute Medical aspects related to phosphate disorders. Endocrine Society. http://press.endocrine.org. DOI: http://dx.doi.org/10.1210/EME.9781936704811.ch20
4. Liu P Y, Jeng CY. Severe hypophosphate-emia in a patient with diabetic ketoacid-osis and acute respiratory failure. J Chin Med Assoc.2004: Jul 67(7):355-9.
5. Brunelli SM, GoldfarbS. Hypophosphate-mia: clinical consequences and manage-ment. J Am SocNephrol . 2007 Jul; 18(7):1999-2003. Epub 2007 Jun 13.
6. Wilson HK,Keuer SP, Lea AS ,Boyd AE ,EknoyanG.Phosphate therapy in diabetic ketoacidosis.Arch.Intern Med. 1982 Mar;142(3):517-20
7. De Oliveira Iglesias SB, Pons Leite H, de Carvalho WB. Hypophasphatemia induced seizure in a child with diabetic ketoacidosis. Pediatric Emerg Care. 2009Dec;25(12):859-61
8. Alvin Powers. Diabetes mellitus :management and therapies. In Harrison’s text book of Medicine, 19 th edition, Dennis L Kasper et.al eds, Unites states of America, McGraw-Hill 2012 ; 418, volume 2; 2407-2422.
9. Vanamali D, Pradhan B, Mallikarjuna Y, Reddy R. Clinical profile of Diabetic ketoacidosis in adults. 2012; May-Aug: vol(2):80-86.
10. Dyanne P Westerberg. Diabetic ketoacid-osis: Evaluation and treatment. American Family Physician:2013Mar1:87(5):337-346.
11. Kebler R, Mc Donald FD, Cadnapaphor-nchai P. Dynamic changes in serum phosphorus levels in Diabetic Ketoacidosis. Am J Med.1985 Nov; 79(5):571-6.
12. Ganapathy VP, Palaniswami VA, Vinod P, Narayan L, Sahoo T, Das RR.Severe symptomatic hypophosphatemia with thrombocytopenia in a child with diabetic ketoacidosis. Journal Of Comprehensive Pediatrics .2009;48(16):1391-5.
13. Miller DW,SlovisCM,Hypophosphatemia in the emergency department therapeutics. Am J Emerg 2000Jul;18(4):457-61.
14. Ditzel J, Lervang HH. Disturbances of inorganic phosphate metabolism in diabetes mellitus: clinical manifestations of phosphate depletion syndrome during recovery from diabetic ketoacidosis. Diabetes MetabSyndr Obes.2010:3:319-324.
15. Luda Khait, Erik D Schraga. Hypophosph-atemia in Emergency Medicine.http: //emedicine.medscape.com/article/767955.
16. Wilson HK,Keuer SP, Lea AS, Boyd AE, EknoyanG.Phosphate therapy indiabetic ketoacidosis. Arch Int Med1982; 142(3):517-520.
17. Megarbane B, Guerrier G, Anne Blancher A,Meas T, Guillausseau P J, Baud FJ.A possible hypophosphatemia-induced, life-threatening encephalopathy in diabetic ketoacidosis: a casereport. Am J Med Sci 2007 Jun;333(6):384-6.
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.119
