Immeasurable levels of serum phosphate – an unidentified cause of respiratory failure in a diabetic patient [Nemjerljive vrijednosti fosfata u serumu - ne prepoznati uzrok respiratorne slabosti u bolesnika s dijabetesom]

Špiček-Macan, Jasna and Hodoba, Nevenka and Kolarić, Nevenka and Nikolić, Igor and Majerić-Kogler, Višnja and Popović-Grle, Sanja (2010) Immeasurable levels of serum phosphate – an unidentified cause of respiratory failure in a diabetic patient [Nemjerljive vrijednosti fosfata u serumu - ne prepoznati uzrok respiratorne slabosti u bolesnika s dijabetesom]. Collegium Antropologicum, 34 (4). pp. 1457-1460. ISSN 0350-6134

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Abstract

We report a case of immeasurable levels of serum phosphate in a patient with juvenile type Diabetes mellitus and diabetic ketoacidosis who developed respiratory failure. A 27-year-old female with juvenile type insulin-dependent Diabetes mellitus was admitted because of suspected acute mediastinitis and respiratory failure, probably, among other responsible factors, caused and complicated by undetectable levels of serum phosphate. The serum phosphate concentration three days after aggressive treatment was only 0.2 mmol/L. Furthermore, a significant improvement in weakness and lethargy was observed. To the best of our knowledge, this is the first described case of immeasurable levels of serum phosphate. In patients with Diabetes mellitus, serum phosphate concentrations should be routinely checked in order to avoid additional complications.

Abstract in Croatian

Prikazujemo bolesnicu s juvenilnim tipom insulin – ovisnoga dijabetes mellitusa i dijabetičkom ketoacidozom u koje se razvila respiratorna slabost uz nemjerljive vrijednosti fosfata u serumu. Bolesnicu smo hospitalizirali zbog sumnje na akutni medijastinitis i respiratorne slabosti što je vjerojatno uzrokovala i dodatno komplicirala »afosfatemija«, tj. nemjerljiva vrijednost fosfata u serumu. Ordinirali smo kontinuiranu infuziju inzulina i kalij fosfata. Unatoč intenzivnome liječenju, vrijednost fosfata u serumu nismo mogli brzo korigirati i tri dana kasnije, koncentracija fosfata u serumu bila je samo 0,2 mmol/L. Ipak, nastupilo ne značajno poboljšanje respiratorne slabosti i letargije. Koliko je autorima poznato, ovo je prvi prikaz nemjerljivih vrijednosti fosfata u serumu, uz kritički pregled literature. Koncentraciju fosfata u serumu treba rutinski kontrolirati u bolesnika s dijabetesom da bismo izbjegli dodatne komplikacije.

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