112 - Prevalence Of Hypophosphatemia In Pediatric Diabetic Ketoacidosis (DKA) Patients In An Inner City Community Hospital

Poster Number: 112
Publication Number: 112.307

IZZELDIN H. ELMUBARAK, bronxcare health system, Bronx, NY, United States; Adeola O. Awujoola, Bronxcare Health System - - Bronx, NY, Bronx, NY, United States; shafa eloud, bronxcare health system, new york, NY, United States; cynthia angeles, BronxCare Health System, New York, NY, United States; Mariell E. Dominguez German, BronxCare Health System, Elmwood Park, NJ, United States; Urav K. Shah, Children's Hospital of Michigan, Detroit, MI, United States; Joselyn Salvador-Sison, Icahn School of Medicine at Mount Sinai, Bronx, NY, United States; jane fong, BronxCare Health System, Bronx, NY, United States

Background: DKA is an acute complication of diabetes mellitus and is the leading cause of mortality. Hypophosphatemia may develop in DKA but anecdotally has been so prevalent in our patients that our standard intravenous fluids for DKA contain potassium phosphate even though this is not routinely recommended per current guidelines.  Yet still we noted many of the patients required phosphate supplementation to attain normal levels.

Objective: To determine the prevalence of hypophosphatemia among pediatric DKA patients and to identify factors associated with lowest phosphate level during their treatment.

Design/Methods: We did a retrospective chart review of all DKA episodes encountered at BronxCare Pediatric Intensive Care Unit from 2009 to 2019. Demographic and laboratory parameters were extracted. Degree of hypophosphatemia was categorized into: None (≥2.5 mg/dL), mild (2-2.49 mg/dL), moderate (1.5-1.99 mg/dL) and severe ( < 1.5 mg/dl). Chi-square analysis was used for categorical variables, while ANOVA and correlation test were used for the normally distributed continuous variables. Significant variable in the bivariate analysis were modelled with a multiple linear regression analysis to determine factors independently associated with lowest level of serum phosphate.

Results: There were 113 subjects with 213 DKA episodes with mean subject age of 16 years and 52.4% female patients.  44% had hypophosphatemia and 11% had severe hypophosphatemia. The mean lowest phosphate level recorded during treatment was 2.75 mg/dl ± 1.08. Hypophosphatemia severity significantly differed based on DKA severity (Fig 1). Serum pH, serum bicarbonate, magnesium, and initial phosphate levels were positively correlated with serum phosphate level while age and HBA1C were negatively correlated (Table 1). Of all these variables, only pH (β:4.2, p-value,0.001), initial phosphate (β:0.173, p-value,0.001), and age (β:-0.05, p-value,0.001) remain as independent predictors of hypophosphatemia (Table 2).Conclusion(s): This is the first study to look at the prevalence of hypophosphatemia in DKA and its predictive factors in pediatrics. The 44% prevalence of hypophosphatemia among our subjects is lower than reported in adults by Shen et al (90%) and Amarens et al (74%) with higher mean nadir phosphate level (2.75 mg/dl), compared to 1.8 mg/dl (Shen et al) and 1.7 mg/dl (Amarens et al). We attribute this difference to the routine addition of potassium phosphate. Using initial serum phosphate, pH and age as independent predictors of hypophosphatemia may help identify patients who are more likely to require additional phosphate supplementation.
CV - Jan 2022CV Jan 2022.pdf
Fig 1: Degree of hypophosphatemia by DKA severityFigure showed degree of hypophosphatemia by DKA severity. Hypophosphatemia and degree of acidosis were categorized into severity levels, and presented as count. Comparisons between groups were made using Pearson Chi square test. P < 0.05