Impaired cardiac and neurological function with mild hypophosphatemia during insulin therapy for diabetic ketoacidosis and marked improvement with phosphate supplementation: A case report

• Published in: Journal of diabetes investigation Vol. 12; no. 3; pp. 454 - 458
• Main Authors: Yoshida, Tomohiko, Takemoto, Minoru
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.03.2021; John Wiley and Sons Inc; Wiley
• Subjects: Adenosine triphosphate; Antibodies; Cardiovascular Diseases - chemically induced; Case Report; Case Reports; Consciousness; Consciousness Disorders - chemically induced; Creatinine; Diabetes; Diabetes mellitus; Diabetic ketoacidosis; Diabetic Ketoacidosis - drug therapy; Ejection fraction; Electrocardiography; Glasgow Coma Scale; Glucose; Hemoglobin; Humans; Hypophosphatemia; Hypophosphatemia - chemically induced; Insulin; Insulin - administration & dosage; Intravenous administration; Ketoacidosis; Kinases; Laboratories; Male; Middle Aged; Patients; Peptides; Phosphate; Supplements; Treatment Outcome; Ultrasonic imaging; Hypophosphatemia; Phosphate; Diabetic ketoacidosis
• ISSN: 2040-1116; 2040-1124
• DOI: 10.1111/jdi.13357

Insulin treatment for diabetic ketoacidosis occasionally results in hypophosphatemia, which is often mild and does not require treatment. However, we experienced a case in which intravenous insulin administration resulted in myocardial injury and altered consciousness despite mild hypophosphatemia. Phosphate replacement therapy resulted in a marked improvement in symptoms. As overlapping conditions that result in hypophosphatemia can cause severe complications after insulin therapy for diabetic ketoacidosis, even in patients with mild hypophosphatemia, physicians should pay more attention to changes in phosphate levels in patients undergoing treatment for diabetic ketoacidosis. Hypophosphatemia resulting from insulin treatment of diabetic ketoacidosis usually does not require special treatment. However, if the conditions that cause hypophosphatemia overlap, severe complications might occur, and caution is required.