Abstract: Objective　To summarize the clinical data of diabetic ketoacidosis （DKA） in children with type 1 diabetes complicated with hypophosphatemia， and to explore the incidence and prognosis of hypophosphatemia during DKA treatment. Methods　A total of 133 children with type 1 diabetes complicated with DKA admitted to the Department of Genetics and Endocrinology of Guangzhou Women and Children's Medical Center from January 2016 to June 2020 were analyzed retrospectively. The serum phosphorus levels were detected 4 to 24 hours after admission， and the related factors affecting the changes of blood phosphorus in DKA children were analyzed. Results　Among 133 children with DKA， 55 （41%） were male and 78 （59%） were female. The age ranged from 6 months to 15 years， with an average age of （6.7 ± 3.9） years. The newly diagnosed type 1 diabetes accounted for 72%. Among the children， 75 cases （56%） had hypophosphatemia during DKA， of which 41（31%） had 0.81~1.29 mmol/L， 22（16%） had 0.61～0.81mmol/L of blood， 10 （7.5%） had 0.38～0.61mmol/L phosphorus， and 2 （1.5%） had blood phosphorus < 0.38mmol/L. There were significant differences in pH， HCO3-， BE-B， blood potassium and blood chlorine between normal and low blood phosphorus groups. The acidosis and age≤5 years old were the risk factors for the severity of low blood phosphorus in children with DKA. None of the 75 children with hypophosphatemia had clinical symptoms related to hypophosphatemia and were not treated with phosphate. The 34 children with blood phosphorus<0.81mmol/L had normal blood phosphorus after 72 hours. Conclusion　Hypophosphatemia are prone to occur during DKA treatment. For DKA children with mild hypophosphatemia， routine phosphate suppleme-ntation is not necessary. Mild hypophosphatemia during DKA treatment does not cause serious clinical consequences， so it is recommended to monitor blood phosphorus only in children with severe hypophosphatemia.

Key words: hypophosphatemia, child, type 1 diabetes, diabetic ketoacidosis

摘要： 目的　总结儿童1型糖尿病酮症酸中毒（DKA）合并低磷血症的临床特点，探讨DKA治疗期间低磷血症的发生率及预后。方法　回顾性分析2016年1月至2020年6月于广州市妇女儿童医疗中心遗传与内分泌科住院治疗的133例合并DKA的1型糖尿病患儿临床资料，分析入院后4～24h血磷水平，并对影响儿童血磷变化的相关因素进行分析。结果　133例DKA患儿中男55例（41%），女78例（59%），年龄6月龄至15岁，平均年龄（6.7±3.9）岁，新发1型糖尿病占72%。75例（56%）患儿出现血磷降低，其中41例（31%）患儿血磷0.81~1.29 mmol/L，22例（16%）患儿血磷0.61～0.81mmol/L，10例（7.5%）患儿血磷0.38～0.61mmol/L，2例（1.5%）患儿血磷<0.38mmol/L。正常血磷组与低血磷组之间pH值、碳酸氢根（HCO3-）、碱剩余（BE-B）、血钾、血氯差异均有统计学意义。酸中毒、年龄≤5岁为影响儿童DKA时血磷降低严重程度的危险因素。75例低血磷患儿均未出现低磷血症相关临床症状，未补充磷酸盐治疗。34例血磷<0.81mmol/L的患儿于72h后复查血磷均正常。结论　儿童DKA诊疗过程中容易发生低磷血症，对于轻度低磷血症的DKA患儿，不需要常规补充磷酸盐治疗。DKA治疗期间的轻度低磷血症并未引起严重临床后果，建议仅对严重低磷血症患儿进行血磷监测。

关键词: 低磷血症, 儿童, 1型糖尿病, 糖尿病酮症酸中毒