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What is the Type of fluid in DKA management ? When I use hypotonic or isotonic saline ??
- The initial fluid replacement should start immediately with isotonic solution (0.9% sodium chloride or Ringer lactate). The typical volume is 10-20 mL/kg over 20-30 minutes, repeated as needed.
- Estimate the hydration status. Assume 5%-7% dehydration if moderate DKA and 10% dehydration if severe DKA.
- Replace the fluid deficit.
- Infuse 0.9% sodium chloride (normal saline) or Ringer lactate for at least 4-6 hours.
- After 4-6 hours, use a solution with 0.45%-0.9% sodium chloride or Ringer lactate for subsequent fluid administration with added potassium (chloride, phosphate, or acetate).
- Aim to replace fluid deficit evenly over 24-48 hours.
- Rate needed is rarely > 1.5-2 times the daily maintenance requirement based on age and weight or body surface area.
- Urinary losses should not be added to the calculation for replacement fluid.
- The sodium content of fluid may need to be increased if hyponatremia (using corrected serum sodium level), but large amounts of 0.9% sodium chloride (normal saline) are associated with hyperchloremic metabolic acidosis.
- Avoid excessive fluid infusion rates to reduce the risk of cerebral edema. This is a rare but often fatal complication.
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- Wolfsdorf J, Glaser N, Sperling MA; American Diabetes Association. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care. 2006 May;29(5):1150-9.
- Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022 Nov;23(7):835-856.
After the 4 to 6 hr in management
The final concentration of saline in IV fluid must be between .45 to 0.9 ( true or false)?
When we shift to half normal saline ? If there is positive Na trend only ??
What about monitoring osmolality? If it is still high and there is positive Na trend , can I shift to hypotonic saline or not ??
If there is sign of cerebral edema and RBSL fall <70 , what about rate and type of fluid in these case and in general in cerebral edema ?
1. In the first 6 hours, the patient must take isotonic normal saline even if corrected Na is high (True or False)?
True.
During the initial phase (first 4–6 hours), 0.9% NaCl (normal saline) is recommended to restore intravascular volume, regardless of corrected sodium, as cerebral perfusion and intravascular volume are the priorities. Adjustments to sodium concentration come after initial stabilization.
2. During the first 6 hours, if the RBSL falls <300 mg/dL, can we add glucose to normal saline?
Yes.
Once glucose falls to ~250–300 mg/dL, add 5–10% dextrose to prevent hypoglycemia and support gradual decline in glucose.
For example:
Switch to D5NS (5% dextrose in normal saline)
3. How many mEq/L in isotonic saline?
154 mEq/L.
In the first 6 hr , pt must take isotonic normal saline even corrected na is high ( true or false)??
During first 6 hr , if the RBSL fall <300mg/dl can we add glucose to normal saline ??
How many meq/liter in isotonic saline
154 or from 130 to 154??