Introduction</h5> The optimal volume and rate of initial intravenous (IV) fluid replacement in diabetic ketoacidosis (DKA) in the pediatric population is controversial. In the setting of DKA, the presence of hyperglycemia leads to osmotic urinary diuresis with subsequent dehydration. Dehydration in turn stimulates a stress response with counter-regulatory hormone production, leading to greater insulin resistance, thus perpetuating a cycle of hyperglycemia and further fluid loss. In an attempt to truncate the production of counter-regulatory hormone production, some authors have advocated for more aggressive fluid rehydration for patients in DKA (1) .</P>In 1989, Adrogue et al. published a small prospective study evaluating the effect of initial volume of fluid administration in adults presenting with DKA (2) . Their data suggested that more modest amounts of infused fluids in the first 4 h of treatment resulted in a more rapid recovery of acid–base status and shorter hospital stay, which correlated with a reduction in medical costs. One theoretical explanation for these findings is depletion of keto-anion salts in the urine among normotensive patients with DKA treated with aggressive amounts of intravenous fluids (3) . Keto-anions serve as substrates for bicarbonate regeneration, but administration of IV saline leads to keto-anion excretion
Journal of Emergency Medicine – Elsevier
Published: Apr 1, 2016
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