Diabetic ketoacidosis is associated with severe phosphate depletion due to excessive urinary losses, and once insulin treatment is started levels will fall, because phosphate, like potassium, is taken up by the cells. Although plasma concentrations may fall in adults to levels known to have been associated with impaired cardiac function, respiratory failure and reduced red cell 2,3-diphosphogly-cerate concentrations, these complications are rarely seen, and have not been reported in children. There is no evidence that replacement is beneficial; it may precipitate symptomatic hypocalcaemia.

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