A Study on Metabolic Abnormalities in Patients with Diabetic Ketoacidosis (Inducing Serum Phosphate)

The ketaocidosis is one of the acute complication in patients with diabeds mellitus and its mortality rate is much decreased after low dose insulin infusion therapy. Clinically, diabetic ketoacidosis showed metabolic abnormalities such as metabolic acidosis, fluid-electrolyte imbalance and hypophosphatemia. Many studies are now available about its mechanism or treatment for the better prognosis. This study included 20 cases of diabetic ketoacidosis who had been admitted to the Department of Internal Medichine at Ewha Womans University Hospital, from March 1982 to May 1984. We observed the correlation between serum phosphate and other metabolic abnormalities. The results obtained were as follows; 1) Diabetic ketoacidosis was more common in female than male. The ratio of male to female was 1:1.85. The age incidence was the highest in 6th decade(35%). The first diagnosis was 3 cases(15%). 2) The commonest precipitating cause was infection(8 cases, 40%). 3) The requiring fluid amount was 6.0+3.01 to correct fluid-electrolyte imbalance. The mean value of serum osmolarity was 309.0+23.7 mOsm/L, serum sodium 130±17.9-mEq/L serum potassium 3.0+1.3mg/dl, urea nitrogen 30.4+20.0mg/dl, bicarnate 10.85+8.5mEq/dl and blood ketone from ++ to +++. 4) The mean value of blood glucose was 575.6+242.8mg/dl. The rate of decrease of glucose was 82.7+47.2mg/dl/hr after insulin therapy. The time of decreased blood sugar level below 250mg/dl was 5.72+2.5hr and the priming dose of insulin was 11.4+6.8u. The infusion rate of insulin was 4.9+1.56u/hr and total amount of insulin was 56.6+28.7u for correction of electrolyte imbalance. 5) The comparison of group A(↓serum phosphate 2.5mg/dl, 5 cases) with group B(↑serum phosphate 2.5mg/dl, 10 cases) : The mean value of serum phosphate was 1.5+0.4mg/dl in group A and 3.8+09mg/dl in group B. The mean value of glucose was significantly higher in group A(796.6+312mg/dl) than in group B(508+164.7mg/dl)(P<0.005) and the mean value of the serum pH was significantly lower in group A(7.058+0.124) than in group B(7.339+0.163)(P<0.01). However there was no significant correlation between two groups in serum osmolarity, sodium, potassium, insulin amount and correction time. 6) The common complications of ketoacidosis were infection(3 cases, 15%) and myocardial infarction(2 cases, 10%). The mortality rate was 5%(1 case) and its cause of death was sepsis with disseminated intravascular coagulation.