Oral Abstract Abstract
Prevalence of Hypophosphatemia in children with Diabetic Ketoacidosis
L Alexis Anand, Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia; MA Nur Syahirah, 1.Paediatric Unit, Faculty of Medicine and Medical Sciences, University Sains Islam Malaysia, Nilai, Malaysia, 2.Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia; M Yazid Jalaluddin, 1.Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia, 2.Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Azriyanti Anuar Zaini, 1.Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia, 2.Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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In diabetic ketoacidosis (DKA), hypophosphatemia may occur due to phosphaturia and intracellular phosphate shift during insulin and fluid repletion. Although ISPAD recommends monitoring, guidelines on routine check are unclear.
This is a retrospective cohort study among children with Type 1 Diabetes Mellitus(T1DM) admitted with DKA from 2017 until 2021 in University Malaya Medical Centre(UMMC). Hypophosphatemia is defined as serum phosphate <0.80mmol/L(severe), 0.8-1.0 mmol/L(moderate) and > 1.1mmol/L(normal).
Eighty-nine children with T1DM was analysed, but only 47 were included with seventy presentations of DKA. Thirty (43%) presentations were recurrent DKA(14 patients). Twenty-seven (51%) were males, 47% Malays, 31% Indian, 20% Chinese and 1% was other ethnicity. There were 47% severe, 36% moderate and 17% mild DKA presentations. Mean age at diagnosis was 8.6±3.1 years, and mean age at DKA was 11±4 years. Of the recurrent DKA’s, mean duration of diagnosis was 4.4 years (0.5-8 years). Mean HbA1C was 12.6±2.5 %. Hypophosphatemia was present in 78% (55/70) [mean 0.77± 0.4mmol/L] and 50% had severe hypophosphatemia with mean value of 0.46±0.18mmol/L. Mean onset of hypophosphatemia after DKA presentation was 12.3±1.2 hours. Amongst children with severe hypophosphatemia, 74% (26/35) had severe DKA (mean pH 6.99±0.13; mean HCO3 7±2.2). Twenty percent(7/35) was given >20mls/kg fluid boluses. Five of 6 children intubated had severe hypophosphatemia. Twenty-percent (7/35) developed complications with cardiovascular and/or renal injury.
Severe hypophosphatemia is seen in severe DKA, had higher bolus volume and intubation. One in five children with severe hypophosphatemia had other DKA related complications. Routine phosphate monitoring should be done in children with DKA.