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What is the Type of fluid in DKA management ? When I use hypotonic or isotonic saline ??
Hossam Elgnainy Answered question April 17, 2025
- 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.
Mona Edited comment April 19, 2025
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 ?
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??