Project Information

Phosphate replacement in Pediatric Diabetic Ketoacidosis

Project Description: In the setting of a potassium phosphate shortage in late 2012, the UF Health Shand's faced a critical parenteral phosphate shortage. Initially alerts were placed in EPIC to lead prescribers to oral products but in April 2013, the Pharmacy and Therapeutics committee enacted a restriction for all intravenous potassium phosphate products. The product was restricted to: 1) IV phosphate therapy during continuous renal replacement therapy (CRRT), 2) IV phosphate replacement in any patient with a serum phosphorous below 1, and 3) IV phosphate replacement in any patient with a serum phosphorous between 1 and 1.5 when no other oral medications were prescribed. Pediatric patients with diabetic ketoacidosis (DKA) have a profound hypophosphatemia due to intravascular volume depletion. Phosphate has historically been replaced in these patients as a continuous infusion in a two-bag method. During this shortage at UF Health Shand's, continuous phosphate replacement was restricted and patients were treated with enteral phosphate with as needed intravenous phosphate for severe hypophosphatemia. This project aims to see if this restriction resulted in less intravenous phosphate usage with no change in clinically relevant outcomes.

QPI: Christopher, Campbell, (



UF Health Big Aims: Increase Value None

MeSH Keywords: Diabetes Mellitus, Type 1, Electrolytes, Pediatrics, Diabetic Ketoacidosis, Pediatric critical care medicine