When a patient has diabetic ketoacidosis (DKA), is it necessary to correct the potassium using both potassium chloride and potassium phosphate (in a 2:1 ratio)? Can one use potassium chloride only?
—DENNIS A. FITO, MD, Oklahoma City

It is always tempting to replenish phosphate in patients with DKA, especially if their phosphate is low. While this is not incorrect, it is likely unnecessary. Many inpatient pharmacies will take a longer time to provide potassium phosphate than they will potassium chloride. In addition, several studies have not found any benefit to replenishing phosphate as part of the acute management of DKA (Arch Intern Med. 1982;142:517-520 and J Clin Endocrinol Metab. 1983;57: 177-180). These studies show that phosphate replenishment does not shorten duration of DKA, affect insulin doses required, or reduce morbidity and mortality
—Lyle Mitzner, MD