How does hypophosphatemia occur during refeeding or DKA treatment, and when should phosphate replacement be considered?

• A. Insulin drives phosphate into cells; supplement if phosphate <1 mg/dL or large drops or symptomatic.
• B. Phosphate replacement is always given regardless of level.
• C. Phosphate replacement is never used during DKA.
• D. Phosphate rises spontaneously with fluids.

Answer: (B)