Rehydration for Diabetic Ketoacidosis in Children

Brain injury is an uncommon but important complication of pediatric diabetic ketoacidosis. One hypothesis has been that rapid infusion of intravenous fluids during treatment causes a reduction in serum osmolality, leading to brain edema and injury. Current recommendations, based on retrospective studies, suggest using a slow infusion of isotonic fluids. In a multicenter randomized clinical trial
with a 2×2 factorial-design, investigators evaluated 1,389 episodes of diabetic ketoacidosis in 1,255 children from 13 urban emergency departments in the United States. The children were assigned to either a rapid or a slow infusion strategy, and all received an initial bolus of 10 ml of 0.9% sodium chloride solution per kilogram. The rapid infusion group received an additional bolus of 10 ml of 0.9% sodium chloride solution per kilogram, and a fluid deficit of 10% of body
weight was assumed, of which half was replaced over the initial 12 hours and half over the
next 24 hours. The slow infusion group didn’t receive an
additional bolus, and a fluid deficit of 5% of body weight was assumed and was replaced evenly over 48 hours. Within each infusion group, children were
assigned to either 0.45% or 0.9% sodium chloride solution for replacement after the initial fluid boluses. All other treatments for diabetic ketoacidosis were identical. The primary outcome was a decline in mental status, as defined by a Glasgow Coma Scale score of less than 14. Scores were obtained hourly for 24 hours or until the resolution of diabetic ketoacidosis. There was no significant difference in the
rate of the primary outcome between the rapid and slow infusion groups or between the 0.45% and 0.9% saline groups. Serious adverse events were rare and occurred with similar frequencies in all groups. The authors conclude that neither the rate
of administration nor the sodium content of intravenous fluids significantly influences
neurologic outcomes in children with diabetic ketoacidosis. Full trial results are available at

Leave a Reply

Your email address will not be published. Required fields are marked *