Fluid Therapy in Diabetic Ketoacidosis

Investigators from multiple institutions conducted a randomized controlled trial to assess the effects of rate of administration of IV fluids and sodium chloride (NaCl) content on neurologic outcomes in children presenting with diabetic ketoacidosis (DKA). The study was conducted at 13 ED sites in the Pediatric Emergency Care Applied Research Network. Participants were children 0–18 years old presenting with DKA (defined as a blood glucose >300 mg/dL and either a venous pH <7.25 or serum bicarbonate level <15 mmol/L), and they were randomized using a 2 × 2 factorial design to either fast or slow rehydration with IV fluid that contained either 0.45% or 0.9% NaCl content. All participants received an initial 10 mL/kg IV bolus of 0.9% NaCl fluid. Those randomized to fast rehydration received …