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Eleven patients with diabetic ketoacidosis were given intravenous phosphate in doses (mean 118 mmol; range 83--320 mmol) adequate to maintain normal plasma phosphate, in addition to a standard treatment regime. Prevention of hypophosphataemia stimulated recovery of the initially low red-cell 2,3-diphosphoglycerate concentrations (10.6 +/- 5.8 (SD) mumol/g Hb) after twenty-four hours. In ten control patients (initial concentration 8.1 +/- 4.4 mumol/g Hb) treated without  phosphate replacement, significantly lower red-cell 2,3-diphosphoglycerate concentrations were found between 2 and 6 days after admission (forty-eight hour value for control patients 14.6 +/- 1.6 and for phosphate-treated patients 18.9 +/- 4.1 mumol/g Hb; p less than 0.01). However, no effect on in vivo p 50 or on the availability of oxygen from the blood resulted from the higher 2,3-diphosphoglycerate levels. Maintenance of normal plasma phosphate levels by intravenous phosphate is, therefore, not indicated to improve tissue oxygenation in diabetic ketoacidosis.

diabetologia

Oxygen availability from the blood and the effect of phosphate replacement on erythrocyte 2,3-diphosphoglycerate and haemoglobin-oxygen affinity in diabetic ketoacidosis