Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis

Abstract

<b>IMPORTANCE: </b>Fluid replacement to correct dehydration, acidosis and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA) but little is known about optimal fluid infusion rates and electrolyte content. <p><b>OBJECTIVE</b><b>: </b><a>To</a> evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. </p> <p><b>DESIGN, SETTING, PaRTICIPANTS:</b><b> </b> The current analysis involved moderate or severe DKA episodes (n=714) in children <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial.</p> <p><b>INTERVENTION:</b> Children were assigned to one of four treatment groups using a 2-by-2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration). </p> <p><b>Results: </b>The rate of change of pH did not differ by treatment arm, but PCO<sub>2 </sub>increased more rapidly in the fast vs slow fluid infusion arms during the initial 4 hours of treatment. The anion gap also decreased more rapidly in the fast vs slow infusion arms during the initial 4 and 8 hours. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 hours. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% vs 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) vs slow arms (35.2%). </p> <h4>CONCLUSIONS AND RELEVANCE: In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and PCO<sub>2</sub> than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis. </h4>